FOR OFFICIAL USE ONLY
WALLA WALLA COMMUNITY COLLEGE
500 Tausick Way, Walla Walla, WA 99362
Clarkston Center - PO Box 700, Clarkston, WA 99403
Walla Walla FAX 509.527.3661 • Clarkston FAX 509.758.1725
Website: http://www.wwcc.edu • e-mail: [email protected]
Run St 54
❏ Yes ❏ No
SID #
IF YES, WHEN __________(YEAR)
Please sign here if you choose NOT to provide your SSN # ________________________________________________________
To comply with federal laws, we are required to ask for your Social Security
Social Security Number
Number (SSN) or Individual Taxpayer Identification Number (ITIN). We will
_________________________________________use your SSN/ITIN to report Hope Scholarship/Life Time tax credit, to administer state/federal financial aid, to verify enrollment, degree and academic tran
script records, and to conduct institutional research. If you do not submit your
SSN/ITIN, you will not be denied access to the college; however, you may be
Which campus will you attend?
❏ Clarkston
❏ Walla Walla
Last Name
NON
PD / NP
AEP 55
Tec Prep 83
UPDATE
CR / AUD
Dept. Sent
APPLICATION FOR ADMISSION
HAVE YOU EVER APPLIED FOR OR ATTENDED CLASSES AT WWCC?
RES
subject to civil penalties (refer to Internal Revenue Service Treasury Regu-
81
What quarter do you plan to begin
(check only one)
❏ Summer ❏ Winter Year_________
❏ Fall
❏ Spring
lation 1.6050S-1(e)(4) for more information). Pursuant to state law (RCW
Gender
Mo.
28B.10.042) and federal law (Family Educational Rights and Privacy Act), the Birth Date
college will protect your SSN from unauthorized use and/or disclosure.
❏ Female ❏ Male
First Name
M.l. Previous last names(s)
Address: Number and Street
City
Permanent Address
❏ Check box if address is same as above
Apartment No.
State
City
Zip Code
Telephone
Day (
Evening (
In case of emergency phone:
Name:
Day
Year
)
)
State
Zip Code
E-mail Address:
or non-response will not affect a candidates
WHAT RACE/ETHNICITY DO YOU CONSIDER YOURSELF TO BE? (Optional) Response
consideration for admission
Are you Spanish/Hispanic/Latino ethnicity?
❏ No
❏ Yes, Hispanic/Latino (717)
❏ Yes, Mexican, Mexican American, Chicano (722)
❏ Yes, Puerto Rican (727)
❏ Yes, Cuban (709)
❏ Yes, Other Spanish (Please specify) _________________________________
Please mark one or more boxes to indicate what race you consider yourself to be:
❏ Hispanic/Latino (717)
❏ Vietnamese (619)
❏ Korean (612)
❏ Mexican, Mexican - American (722)
❏ Native Hawaiian (653)
❏ Other Asian (621)
❏ Black/African American (872)
❏ Filipino (608)
❏ Pacific Islander (681)
❏ Native American Indian (597)
❏ Chinese (605)
❏ Japanese (611)
❏ Latin American /South/Central/Caribbean/Other Spanish (799)
❏ Alaskan Native (015)
❏ Other Ethnicity _______________________________ (please specify) ❏ White (800)
U.S. CITIZEN?
❏ Yes ❏ No
If not U.S. citizen, country of citizenship_______________________________ NOTE: Call 527.4283 to see if you qualify for 1079 Status.
or see back panel for description. ( * )
If not U.S. citizen, what is your visa status?
❏ Temporary resident (Alien No. ___________________ ) Attach copy of both sides of alien card.
❏ Visitor
❏ Immigrant/permanent resident (Alien No. ____________________ ) Attach copy of both sides of alien card.
❏ International Student (F or M visa)
❏ Refugee/parolee or conditional entrant (Alien No. _______________________ ) Attach copy of both sides of 1-94 card.
❏ Other (explain) ______________________
WASHINGTON STATE RESIDENCY STATUS
1.
2.
3.
4.
5.
a. Have you lived in the state of Washington continuously for the past twelve months?.................................................................................................................................❏ Yes ❏ No
b. How long have you lived continuously in the state of Washington?.................................................................................................................... ____________Years___________ Months
a. Current drivers license issued in what state?............................................................................................................................................................ _______________________________
b. Current vehicle registration issued in what state?..................................................................................................................................................... _______________________________
For the last calendar year did your mother, father, or legal guardian claim you as a dependent on their federal income tax return?................................................................❏ Yes ❏ No
For the current calendar year, will your mother, father, or legal guardian claim you as a dependent on their federal income tax return?.........................................................❏ Yes ❏ No
a. If you were claimed, or you will be claimed, as a dependent on a federal income tax, return, has your mother, father or legal guardian lived in the state
of Washington continuously for the past twelve months?.........................................................................................................................................................................❏ Yes ❏ No
b. how long has your mother, father, or legal guardian lived continuously in the state of Washington?.................................................................. ____________Years___________ Months
6. Will you be attending this college with financial assistance received from nonfederal agency which is outside the state of Washington?.......................................................❏ Yes ❏ No
If yes, explain:_______________________________________________________________________________________________________________
7. a. If you are active duty military, stationed in the state of Washington, what state is your home of record?__________________________________________
b. Are you the spouse or dependent of someone on active duty in the military stationed in the state of Washington?...................................................................................❏ Yes ❏ No
8. Please check this box if you have been in Washington State foster care for at least one year since your 16th birthday...................................................................................❏ Yes
VETERAN’S INFORMATION
Are you a veteran?
❏ Yes
❏ No
If YES, and you are a Washington state resident, check with Office of Admissions and Registration for tuition waiver. 527.4282
FIRST GENERATION Are you a first generation college student? (Neither parent has a four year degree) ❏ Yes ❏ No
PREVIOUS EDUCATION Have official copies of high school transcript or GED test scores, and all college transcripts sent to WWCC Admissions Office.
Name of last high school attended
Have you completed a GED?
❏ Yes ❏ No
Date you graduated or will graduate Month______ Yr______
If you did not graduate, indicate the highest grade completed ______
If yes, what year? Where?
City, State and County
Name of last college, vocational/technical school attended
Graduated
City and State
❏ Yes ❏ No
Graduated
City and State
❏ Yes ❏ No
Graduated
City and State
❏ Yes ❏ No
Years Attended
From
To
Years Attended
From
To
Years Attended
From
To
IMPORTANT: COMPLETE BACK SIDE OF FORM
EDUCATION INTENT
(Check one)
❏ 1. plan to transfer to a four-year institution
❏ 2. do not plan to transfer to a four-year institution
TRANSFER DEGREE PROGRAMS (check if appropriate)
‰
‰
‰
‰
‰
‰
001 Associate in Arts–DTA
001B Associate in Business–DTA/MRP
004A Associate in Science (Option 1)
004B Associate in Science (Option 2)
004D Associate in Science Agriculture
ELEM Associate in Elementary Education - DTA/MRP
❏ 3. plan to transfer to another community college
OTHER (check if appropriate)
‰
‰
‰
‰
‰
‰
‰
‰
D High School Diploma/GED
E Improve English, Reading or Math skills
J Improving Current Job Skills
K Home & Family
L Personal Satisfaction - Not Degree Seeking
Y Other
TP Tech. Prep
UNDC Undecided
PROFESSIONAL AND TECHNICAL DEGREE & CERTIFICATE PROGRAMS
(If you are a Professional Technical Student check the appropriate program below)
† = Clarkston Campus Degree & Certificate Programs – (All degrees are offered on the Main Campus)
‰‰† 505
‰‰ 110
‰‰ 105B
‰‰ 105A
‰‰ 110D
‰‰† 323
‰‰ 709
‰‰ 712
‰‰ 505A
‰‰ 502
‰‰† 745
‰‰† 329
‰‰ 612
‰‰ 612T
‰‰ 838E
‰‰ 823
‰‰ 850
‰‰ 125
‰‰† 402
‰‰† 839
‰‰ 784
‰‰ 768
‰‰ 703
‰‰ 121
‰‰† 547A
Accounting Technology
Agri Business
Agri Science & Tech-Animal Science
Agri Science & Tech–Plant & Soil Science
Agri Business–Wine Marketing & Management
Associate Degree Nursing
Auto Body Repair Technology
Automotive Repair Technology
Bookkeeping Certificate
Business & Management
Carpentry
Certified Nursing Assistant
Civil Engineering Technology
AAS-T Civil Engineering Technology
Corrections Law Enforcement (Certificate Only)
Cosmetology
Culinary Arts
Diesel Equipment Mechanics
Early Childhood Education
Education Paraprofessional
Energy System Tech–Electrical
Energy System Tech–Mechanical
Energy System Tech–Refrigeration & Air Conditioning
Enology & Viticulture
Executive Administrative Assistant
‰‰ 120
‰‰† 267
‰‰ 828
‰‰ 507
‰‰† 527
‰‰ 130
‰‰ 125J
‰‰ 110B
‰‰† 577
‰‰† 565
‰‰ 381
‰‰ 31C
‰‰† 559C
‰‰ 126C
‰‰ 36A
‰‰ 326
‰‰ 808
‰‰ 176
‰‰ 251
‰‰ 501
‰‰ 715
‰‰ 160
‰‰ 130A
‰‰† 814
Farrier Science
Financial Administrative Assistant
Fire Science
Informatics in Digital Design
Informatics in Networking
Irrigation Technology
John Deere Technology
John Deere Dealership Management
Legal Administrative Assistant
Medical Administrative Assistant
Medical Assisting Certificate
Medial Lab Technician (WWCC/YVCC)
Office Assistant
Outdoor Power & Turf Equipment Service Tech. Certificate
Paramedic (WWCC/CBC)
Practical Nursing
Precision Machining Technology
Professional Golf Management
Retailing
Software Design Informatics
Truck Driver Training
Turf Management
Water Resources Technology
Welding Technology
I certify to the best of my knowledge all statements on this form are true.
APPLICANTS SIGNATURE_ __________________________________________________
DATE:________________
If you plan to apply for financial aid, please contact the financial aid office (509) 527-4301 regarding deadlines for
receipt of financial aid information.
* 1079 Status: Effective July 1, 2003, individuals who are not permanent residents or U.S. citizens MAY qualify for resident tuition if they have or will have graduated from a
Washington State high school, or while living in Washington, have received the equivalent of a high school diploma. A three year residency requirement must be fulfilled. Additional
criterion are required. Please contact the Walla Walla Campus Admissions Office, 509.527.4283; toll free 1.877.992.9922.
In compliance with the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act, information concerning campus crime statistics, and other Student
Rights to Know information can be found on-line at http://www.wwcc.edu/
If you are facing layoff, collecting unemployment, or have exhausted benefits and need tuition assistance, call 509-527-4619
Walla Walla Community College is committed to provide equal opportunity and nondiscrimination for all educational and employment applicants as
well as for its students and employed staff, without regard to race, color, creed, national origin, sex, sexual orientation, including gender expression/
identity, marital status, age (over 40), the presence of any sensory, mental, or physical disability, the use of trained guide dog or service animal by a
person with a disability, or status as a Vietnam and/or disabled veteran, National Guard member or reservist in accordance with the Civil Rights Act
of 1964, Title IX of the Education Amendments of 1972, the Federal Rehabilitation of 1973, the Americans with Disabilities Act of 1990, and any other
applicable Federal and Washington State laws against discrimination.
REVISED 5/09 Graphics