For Office Use Only
Date Application &/OR Payment Received: _______________ Receipt # _________________ Date Entered __________ By: ______ Datatel#: ______________
San Juan College Application for Admission
$10.00 Paper Application Fee
Online Application is FREE (http://www.sanjuancollege.edu/apply)
Information About Yourself
1. Name: _____________________________________________________________________________________________________________________________________
Legal Last Name
Legal First Name
Legal Middle Name
2. Mailing Address: _____________________________________________________________________________________________________________________________
Street/PO Box
City
State
Zip Code
3. Phone Number: ______________________________
(Area Code) Home #
_____________________________________
(Area Code) Cell #
4. Social Security Number: ______ ______ ______ - ______ ______ -______ ______ ______ ______ (SSN will not be used as your primary college I.D.)
5. Birth Date: ______/______/_________
6.Gender:
Male
Female
7. Ethnic/Race Origin
a. Do you consider yourself to be Hispanic/Latino?
Yes
No
b. In addition, select one or more of the following racial categories to describe yourself:
American Indian Tribe:________________________________
Asian
Black
Pacific Islander
White
8. Email Address: ______________________________________________________________________________________________________________________________
9. Indicate any other names which may appear on your academic records (This includes maiden or married names): _______________________________________________
10a. Do either of your parents have a college degree?
Yes
11a. Citizenship Status (Choose One):
Permanent Resident
US Citizen
No
10b. If yes,
Two-Year Degree or
Non-Resident Alien
Four-Year Degree?
Other (list): ___________________________________________
11b. If not a US Citizen: Country of Citizenship: ________________________________________________ Are you currently living in the US?
11c. If living in the US: Visa Type: _________________________________________________
Are you in-status?
Yes
Yes
No
No
Emergency Contact Information – REQUIRED
Name: _______________________________________________
Relationship: ___________________________Phone Number: (________)__________________
Military Information
12a. Are you active duty Military?
Yes
No
b. Are you a veteran (served in the Armed Forces)?
Yes
No
c. Are you a spouse or dependent of an
active-duty military member?
Yes
No
For information, required documentation, and deadlines on tuition waivers for Veterans, Active Duty Military, and their spouses and/or dependents, please see
www.sanjuancollege.edu/militaryfriendly.
Academic Information
13. Admission Status (Choose One):
14. When do you plan to start?
New Student
Fall (August) Year: 20________
Transfer Student
High School Early Admission
Spring (January) Year: 20________
High School Dual Credit
Summer (May/June/July) Year: 20________
15. What is your intended major at San Juan College? (Please choose either a, b or c. If more than one is chosen, we will automatically choose the first one listed in option a.)
a. _______________________________________________________ (You MUST choose from one of the available majors offered. See attachment for current majors.)
b.
Major Undecided/General Education: I am not sure what I want to major in, but I do want to seek a degree or certificate. I understand checking this box will allow me to
start taking my core/general education classes.
Updated 12/4/2015
c.
Non-Degree: I am not seeking a degree or certificate at San Juan College. I understand that by checking this box I will not be eligible for Financial Aid.
Information
High School / GED Information
Applicants for admission must submit Official Transcripts from each institution previously attended. If it is determined that fraudulent transcripts have been submitted,
the student may be dismissed from San Juan College.
16a. High School _________________________________________________________________________________________ Did you graduate?
High School Name
City
State
Graduation Year
Yes
No
Not Yet
b. Did you earn a GED?
Yes
No
Not Yet
Yes
No: ____________________ __________________ c. Did you graduate from a Home School Program?
State where GED earned?
Year GED earned
College / University Information
Applicants for admission must submit Official Transcripts from each institution previously attended. If it is determined that fraudulent transcripts have been submitted, the
student may be dismissed from San Juan College. Note: Please do not list High School or GED information here.
Institution
City
State
Dates of Attendance
From
To
Degree or Certificate Earned
Residency Information
If you are claiming New Mexico residency for tuition purposes, you MUST NOT have a driver’s license, vehicle registration or voter registration in another
state. If you ever attended San Juan College under non-residency status, YOU must petition for in-state residency with the Admissions & Records office. For
complete residency information, please refer to the current San Juan College catalog, or call the Admissions Office at (505) 566-3441.
Please answer completely all questions below (We will need to know what state your documentation is issued in.):
17. State of Legal Residence: _______________________________
18. Have you lived in New Mexico for the past 12 months?
19. Are you registered to vote?
□ Yes □ No
□ Yes □ No
If yes, in what state? ________________________
□ Yes □ No If yes, in what state? _________________________
21. Do you own a vehicle that is currently registered?
□ Yes □ No If yes, in what state? _________________________
22. Did you file New Mexico income tax for the previous year?
□ Yes □ No
23. Did you pay in-state tuition at an institution outside of New Mexico in the past 12 months?
□ Yes □ No
24. Did you attend a New Mexico high school for at least one year?
□ Yes □ No
20. Do you have a current driver’s license or state issued ID card?
Signature and Statement of Understanding
It is the policy of San Juan College to not discriminate on the basis of sex, disability, race, color, religion, or national or ethnic origin in its admission policy, financial aid,
or other school administered programs. This policy is enforced by federal law under the Title IX of the Education Amendments of 1972, Title VI of the Civil Rights Act of
1964, and Section 504 of the Rehabilitation Act of 1973. Additionally, SJC grants the same tuition or state-funded financial aid to all persons in compliance with SB 582
(2005).
Please initial that you have read and understand the following:
________ I understand that San Juan College does not automatically send out billing statements and that I am responsible for knowing when tuition payment is due. I
further understand that failure to pay my tuition will result in my classes being dropped for the semester.
I certify that all information given in this application is complete and accurate to the best of my knowledge. I understand that misrepresentation in any statement or failure
to abide by college academic regulations will be considered grounds for denial of admission, cancellation of registration or suspension from SJC.
__________________________________________________________________
___________________________________________________
Signature of Applicant
Date
Note: Application will not be processed without your signature.
Updated 12/4/2015
San Juan College Academic Degrees
Programs of Study
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Accounting (AAS.ACCT)
Advanced Petro Production Operations (AAS.APPO)
Auto Body (AAS.AUBO)
Automotive Service Educational Program (AAS.ASEP) *
Automotive Technology (AAS.AUTE)
Biology (AS.BIOL)
Building Trades (AAS.BLDT)
Business Administration (AA.BADM & AAS.BADM)
Chemistry (AS.CHEM)
Chrysler Automotive Program (AAS.CAPP) *
Computer Science (AS.COSC)
Cosmetology * (AAS.COSM)
Dental Hygiene * (AA.LBAS.DHYG)
Diesel (AAS.DIME)
Digital Media Arts & Design (AAS.DMAD)
Drafting – Civil Drafting & Design (AAS.DRFT.CIVL)
Drafting – Mechanical Drafting & Design (AAS.DRFT.MECH)
Early Childhood Education (AA.ECED)
Engineering (AS.ENGR)
Engineering Technology (AS.ENTE)
Fire Science (AAS.FIRE)
Fundamentals of Petroleum Production Operations * (AAS.PLOP)
General Education (AA.GEN) (for undecided degree-seeking)
General Science (AS.GSCI)
Geology (AS.GEOL)
Health Information Technology * (AA.LBAS.HITP)
Horticulture (AAS.HORT and AAS.HORT.LAND)
Human Services – Criminal Justice
(AA.HMSV.CRJS or AAS.HMSV.CRJS)
Human Services – Generalist Studies
(AA.HMSV.GETR or AAS.HMSV.GETR)
Human Services – Substance Abuse
(AA.HMSV.SAST or AAS.HMSV.SAST)
Industrial Maintenance Mechanic (AAS.INME)
Industrial Process Operator * (AAS.IPOP)
Instrumentation & Controls Technology (AAS.INST)
Legal Assistant (AAS.LEAS)
Liberal Arts (AA.LBAS)
Machine Shop Technology (AAS.MASH)
Mathematics (AS.MATH)
Medical Billing & Coding* (AA.LBAS.MDCD)
Medical Laboratory Technology * (AA.LBAS.MLTS)
Native Studies (AA.NATV)
Natural Gas Compression * (AAS.COMP)
Occupational Safety* (AAS.SAFE.OSAF)
Occupational Therapy Assistant (AA.LBAS.OTAP)
Paramedic (AAS.PARA or AS. PARA)
Physical Education (AA.PHED)
Physical Therapist Assistant * (AA.LBAS.PTAP)
Physics (AS.PHYS)
Police Science (AA.POLI)
Pre-Health Science (AS.PHSC)
Pre-Medical Science (AS.PMED)
Psychology (AA.PSYC)
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Respiratory Therapy Assistant* (AA.LBAS.RESP)
Surgical Technology * (AS.PHSC.SURG)
Teacher Education (Elementary – AA.EDUC.ELEM, Secondary –
AA.EDUC.SEC or Special Ed – AA.EDUC.SPED)
Technical Theatre (AAS.THEA)
Toyota Technical Education Network (AAS.TTEN) *
Veterinary Technology * (AAS.VETT)
Welding (AAS.WELD)
Associate of General Studies (non-transferable degree)
+
Associate Degree in Nursing
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Nursing (RN) * (AA.LBAS.PNUR)
Pre-Nursing (AA.LBAS.PNUR)
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Administrative Office Assistant (CER.AOAP)
Advanced Emergency Tech. (CER.AEMT)
Advanced Petro Production Operations (CER.APPO)
Alternative Teacher Licensure Certificate (Elementary CER.ELEM, Secondary – CER.SEC or Special Ed – CER.SPED)
Barber (CER.COSM.BARB)
Bookkeeping (CER.ACCT.BKKP)
Business Foundations I & II (CER.BADM.FDI & FDII)
Commercial Driver’s License (CER.CDLT)
Cosmetology* (CER.COSM)
Cosmetology Instructor* (CER.COSM.INST)
Creative Writing (CER.LBAS.CRWR)
Drafting (CER.DRFT)
Emergency Services Technician (CER.EMT)
Esthetician* (CER.COSM.ESTH)
Fundamental Skills in Health Careers (CER.HLTH.FUND)
Fundamentals of Petroleum Production Operations Certificate
(CER.PLOP)
General Education Transfer Certificate (CER.LBAS.TRAN)
Geographic Information System Certificate (CER. GIST)
Horticulture (CER.HORT)
Instrumentation (CER.INST)
Machine Shop CNC Operator (CER.MASH.CNC)
Machine Shop Lathe Operator (CER.MASH.LATH)
Machine Shop Mill Operator (CER.MASH.MILL)
Management (CER.BADM.MGNT)
Manicuring & Pedicuring* (CER.COSM.MCPC)
Medical Insurance Coder/Biller * (CER.MDCD)
Natural Gas Compression* (CER.COMP)
Nursing Assistant Health Care (CER.HLTH.CNA)
Object-Oriented Computer Programming (CER.COSC.OOCP)
Occupational Safety (CER.SAFE.OSAF)
Paramedic Certificate (CER.PARA)
Patient Care Unit Assistant (CER.HLTH.PCUA)
Payroll Accounting (CER.ACCT.PAYR)
Pharmacy Technician Certificate (CER.PHAR)
Police Science Certificate (CER.POLI)
Veterinary Assistant Certificate (CER.VETT)
General Welding Certificate (CER.WELD-1Year)
Advanced Welding Certificate (CER.WELD-2Year)
Certificates
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*Programs with an asterisk require a separate application in addition to the San Juan College application. Contact the program directly
for information regarding program details and application deadlines.
Updated 12/4/2015
+Must meet with the Director of Advising & Counseling.