APPLICATION FOR ADMISSION

Transcription

1 APPLICATION FOR ADMISSION FALL 20 SPRING 20 SUMMER 20 Oceanside Campus: 1 Barnard Drive, MS 10A, Oceanside, CA San Elijo Campus: 3333 Manchester Avenue, MS 17B, Cardiff, CA FOR Concurrent Initials ADMINISTRATIVE USE ONLY Enrollment Date DIRECTIONS: This application is for credit classes only. Please print in blue or black ink. Complete the entire form and return to either campus. The voluntary provision of your Social Security number will be used to assist the state of California in evaluating community college student success. Not providing your Social Security number could delay financial aid processing Please print your name on the side of the form. and accurate IRS reporting for tax credits. 1. Legal Name: Last First Middle Initial 2. Social Security Number: Sex: Male Female 4. Date of Birth: 5. Age: Birthplace: Month / Day / Year Years 6. Your marital status: Single Married Divorced Widowed 7. Telephone: ( ) 8. Address: Area Code Telephone Number 9. Local Residence: (do not use a Number Street Apartment Number P.O. Box) City State Zip LAST NAME: FIRST NAME: 10. Local Mailing Address: Number Street Apartment Number (if different from above) City State Zip 11. Your Citizenship Status: U.S. Citizen Amnesty Permanent Resident Refugee/Asylee Temporary Resident Student Visa (F1/M1) DACA Other Status If you did not specify U.S. citizen, please indicate the following: CHECK IF NONE Alien Registration Number Or Visa Type Issue Date Expiration Date 12a. Ethnicity: Are you Hispanic or Latino? Yes No 12b. If yes, check one or more: Mexican, Mexican-American, Chicano South American Central American Hispanic: Other 12c. What is your race/ethnicity? (Check one or more. For state and federal statistical reports.) Asian: Indian Asian: Korean Asian: Vietnamese Black or African American Pacific Islander: Hawaiian White Asian: Chinese Asian: Laotian Asian: Other Amer. Indian/Alaskan Native Pacific Islander: Samoan Asian: Japanese Asian: Cambodian Filipino Pacific Islander: Guamanian Pacific Islander: Other 13. Indicate the one that applies to you as of the first day of the semester: Active-duty military Dependent (spouse or child) of active military Veteran (active or reserve) discharged within the last two years Veteran (active or reserve) discharged over a year ago Date of discharge: Currently Reserves or National Guard (non-active) None If you re currently active in the military, or if you were discharged within the last two years, or you are a dependent of an active member in the military, then please answer the following: Home of Record: Country of Record: Currently stationed in California: Yes No MiraCosta College Application for Admission miracosta.edu

2 MAJORS & CODES 14. Select your intended Major or Program of Study. The following is a general list of possible MiraCosta College majors that are available as Certificate programs and/or Associate Degrees majors. See the college catalog for a full listing and breakdown of available programs. If you plan to earn a two-year, Associate degree, select a major from the Associate Degrees list. If you plan on earning a certificate of achievement without an Associate degree OR transfer certificate, choose from the Certificates of Achievement list. SELECT (CIRCLE) ONE of the following codes: ASSOCIATE DEGREES CERTIFICATES OF ACHIEVEMENT ACCTA ASTADMJUST DIGIPHOTOA AATSTUDART AUTOTECHA BIOTRESDVA BOOKKPGA ENTREPRENA MGTA MARKETINGA RETAILMGTA ASTBUSADM ADMINPROFA OFFICEMGRA CHLDASOTA CHLDMTCHA CHLDSSUPA CHLDTCHA AATCOMSTUD COMAPPBUSA COMPROFUNA AACOMPSCI COMPSTUDA NETSYSADMA AADANCE ARCHDESGNA DRAFCADA DRAFCADDSA MECHDESGNA DRAMADTA AATTHEARTS AADRAMARTS AAGERON AATHISTORY LANDSARCHA HORTNURSA HORTSLTMA HOSPMGTA RESTMGTA AAITALIAN AJLAWENFA AALIBARTHN AALIBARTAH AALIBARTBT AALIBARTCA AALIBARTMS AALIBARTMC AALIBARTSS ASTMATH GRAPHDESA WEBDEVDESA MEDOFCPRFA AAMUSPERF MUSAUDRECA LVNURSA REGISNURS REGNURSGS AAPSYCH AATPSYCHOL AAHUMDEV REALESTA REALEENTA AATSOCIOL SURGTECHA Accounting AA Degree Administration of Justice for Transfer AS Degree Art: Digital Photography AA Degree Art: Studio Arts for Transfer AA Degree Automotive Technology AA Degree Biotech: Research and Develop AA Degree Bookkeeping AA Degree Bus Admin: Entrepreneurship AA Degree Bus Admin: Management AA Degree Bus Admin: Marketing AA Degree Bus Admin: Retail Management AA Degree Business Administration for Transfer AS Degree Business Ofc Tech: Administrative Professional AA Degree Business Ofc Tech: Office Manager AA Degree Child Development Associate Teacher AA Degree Child Development Master Teacher AA Degree Child Development Site Supervisor AA Degree Child Development Teacher AA Degree Communication Studies for Transfer AA Degree Computer Applications Professional for Business AA Degree Computer Programming Fundamentals AA Degree Computer Science AA Degree Computer Studies AA Degree Computer Studies & Info Tech: Network and Desktop Sys Admin AA Degree Dance AA Degree Design: Architectural Design AA Degree Design: Computer Aided Drafting AA Degree Design: Computer Aided Drafting and Design AA Degree Design: Mechanical Design AA Degree Drama: Design and Technology AA Degree Drama: Theater Arts for Transfer AA Degree Dramatic Arts AA Degree Gerontology AA Degree History for Transfer AA Degree Horticulture: Landscape Architecture AA Degree Horticulture: Nursery/Horticulture Crop Production AA Degree Horticulture: Sustainable Land and Turf Mgmt AA Degree Hospitality Management AA Degree Hospitality: Restaurant Management AA Degree Italian AA Degree Law Enforcement AA Degree Liberal Arts: Applied Health, Nutrition & Kinesiology AA Degree Liberal Arts: Arts and Humanities AA Degree Liberal Arts: Business and Technology AA Degree Liberal Arts: Creative and Applie d Arts AA Degree Liberal Arts: Mathematics and Sciences AA Degree Liberal Arts: Multicultural Studies AA Degree Liberal Arts: Social and Behavioral Sciences AA Degree Mathematics for Transfer AS Degree Media Arts & Tech: Graphic Design AA Degree Media Arts & Tech: Web Development and Design AA Degree Medical Office Professional AA Degree Music Performance AA Degree Music Technology: Audio Recording Production AA Degree Nursing: Licensed Vocational Nursing AA Degree Nursing: Registered Nursing AS Degree Nursing: Registered Nursing (LVN to RN) AS Degree Psychology AA Degree Psychology for Transfer AA Degree Psychology: Human Development AA Degree Real Estate AA Degree Real Estate Entrepreneurship AA Degree Sociology for Transfer AA Degree Surgical Technology AA Degree ACCTC DIGIPHOTOC AUTOHVACC CASMOGCHKC* AUTOTECHC AUTOMASTC BIOPRTECHC* BIOTRESDVC BOOKKPGC ENTREPRENC* MGTC MARKETINGC RETAILMGTC SOCMEDIAC* ADMINPROFC OFFICEMGRC CHLDASOTC ERINTINCLC CHLDMTCHC CHLDSSUPC CHLDTCHC COMAPPBUSC* COMPROFUNC COMPSTUDC CERTSUPSPC ECOMMRC MCASBUSC* NETSYSADMC DANCEINSTC PILATINSTC ARCHDESGNC DRAFCADC DRAFCADDSC MECHDESGNC DRAMADTC CSUGEC* IGETCC* LANDSARCHC HORTNURSC HORTSLTMC HOSPMGTC RESTMGTC PERFITTRNC YOGAA300C* AJLAWENFC MASSTH500C HOLISTICHC* GRAPHDESC VIDMEDDESC* WEBDEVDESC MEDOFCPRFC MUSAUDRECC* BUSOFMUSC* MUSLIVEPRC* LVNURSC REALESTC REALEENTC SURGTECHC Accounting Certificate Art: Digital Photography Certificate Auto Tech: Auto Elec, Comp, Emiss or HVAC Certificate Auto Tech: California Smog Check Tech Certificate Automotive Technology CA Degree Automotive Technology: Master Technician Certificate Biotech: Bioprocess Technology Certificate Biotech: Research and Develop Certificate Bookkeeping Certificate Bus Admin: Entrepreneurship Certificate Bus Admin: Management Certificate Bus Admin: Marketing Certificate Bus Admin: Retail Management Certificate Bus Admin: Social Media for Business Certificate Business Ofc Tech: Administrative Professional Certificate Business Ofc Tech: Office Manager CA Degree Child Development Associate Teacher Certificate Child Development Early Intervention and Inclusi CA Degree Child Development Master Teacher Certificate Child Development Site Supervisor Certificate Child Development Teacher Certificate Computer Applications Professional for Business Certificate Computer Programming Fundamentals Certificate Computer Studies Certificate Computer Studies & Info Tech: Certified Comp Desktop Support Spclst Certificate Computer Studies & Info Tech: E-Commerce Certificate Computer Studies & Info Tech: Microsoft Certified Appl Specialist Business Certificate Computer Studies & Info Tech: Network and Desktop Sys Admin Certificate Dance Instructor Certificate Dance: Pilates Instructor Certificate Design: Architectural Design Certificate Design: Computer Aided Drafting Certificate Design: Computer Aided Drafting and Design Certificate Design: Mechanical Design Certificate Drama: Design and Technology Certificate General Education: CSU GE Certificate General Education: IGETC Certificate Horticulture: Landscape Architecture Certificate Horticulture: Nursery/Horticulture Crop Production Certificate Horticulture: Sustainable Land and Turf Mgmt Certificate Hospitality Management Certificate Hospitality: Restaurant Management Certificate Kinesiology: Personal Fitness Trainer Certificate Kinesiology: Yoga Instructor (300 Hours) Law Enforcement Certificate Massage Therapist (500 hours) Certificate Massage Therapy: Holistic Health Practitioner Certificate Media Arts & Tech: Graphic Design Certificate Media Arts & Tech: Video and Media Design Certificate Media Arts & Tech: Web Development and Design Certificate Medical Office Professional Certificate Music Technology: Audio Recording Production Certificate Music Technology: Business of Music Certificate Music Technology: Live Performance Audio Certificate Nursing: Licensed Vocational Nursing Certificate Real Estate Certificate Real Estate Entrepreneurship Certificate Surgical Technology Certificate *Indicates a major that is NOT eligible for financial aid. UNDECIDED If you are undecided on your major, select: ** Undecided ** Students who select Undecided will NOT be eligible for financial aid OR veterans benefits. MiraCosta College Application for Admission miracosta.edu

3 15. Indicate the one that applies most recently to you. Enrolling in high school and college courses at the same time (SPC) First time student in college (after leaving high school) (FYR) First time at this college, have attended another college (NTR) Returning to MiraCosta after absence of a main term (RET) Attended MiraCosta last semester; I am continuing (X) 16. Enter the name and city of the high school or home school organization you last attended. Name of High School _ I did not attend high school 17. List the name and location of any college or university you have attended along with the approximate dates of attendance starting with the most recent. Attach an additional page if more than four institutions. 18. Directory information is released to the public. Select NO if you do not want this information released. See Admissions and Records for a list of directory information. No 19. Indicate which statement currently applies to you (select only one). SB11 NOT A HIGH SCHOOL GRADUATE: Not a graduate of, and no longer enrolled in, high school (00000) Will be enrolled in high school in grades and college at the same time (10000) Currently enrolled in adult high school (20000) COLLEGE GRADUATE: Received an associate degree (indicate year received) (7) Received a bachelor s degree or higher (indicate year received) (8) HIGH SCHOOL GRADUATE WITHOUT A COLLEGE DEGREE: Received high school diploma from U.S. school (indicate year received) (3) Passed the GED or received a Certificate of Equivalency (indicate year received) (4) Received Certificate of California High School Proficiency Exam (indicate year received) (5) Received a diploma/certificate of graduation from a Foreign secondary school (indicate year received) (6) MiraCosta College Application for Admission miracosta.edu

4 20. Give your primary goal while attending MiraCosta (select only one). SB14 THESE GOALS DO QUALIFY FOR FEDERAL FINANCIAL AID: Transfer to a 4-year institution to obtain B.A/B.S. degree by earning an associate degree, then transferring (A) Transfer to a 4-year institution to obtain B.A/B.S. degree without earning an associate degree (B) Earn an associate degree (non-vocational) (C) Earn a vocational associate degree (D) Earn a vocational certificate (E) THESE GOALS DO NOT QUALIFY FOR FEDERAL FINANCIAL AID: Discover/formulate career interests, plans, goals (F) Prepare for a new career (acquire job skills) (G) Advance further in current job/career (update job skills) (H) Maintain certificate or license (e.g. nursing, real estate) (I) Educational development (intellectual, cultural) (J) Improve basic skills in English, reading, math (K) Complete credits for high school diploma or GED (L) To move from noncredit course work to credit course work (N) 4-year college student taking courses to meet 4-year requirement (O) Undecided on goal (M) 21. Regardless of your age, indicate the education levels of the parents and/or guardians who raised you: Parent or Guardian 1 Parent or Guardian 2 Grade 9 or less Grade 9 or less Grade 10, 11 or 12 but did not graduate Grade 10, 11 or 12 but did not graduate High School Graduate High School Graduate Some college but no degree Some college but no degree A.A./A.S. Degree A.A./A.S. Degree B.A./B.S. Degree B.A./B.S. Degree Graduate or professional degree beyond a B.A./B.S. Graduate or professional degree beyond a B.A./B.S. Not applicable/no parent or guardian Not applicable/no parent or guardian Unknown Unknown 22. What is your household income? No income $1 $25,000 $25,001 $50,000 $51,001 $75,000 $75,001 $100,000 $100,001 and above 23. I am a former or current Foster Youth (court ordered Foster Care), and am interested in financial aid and/or other benefits and services available to Foster Youth. RESIDENCY REQUIREMENTS The residency rules as established by Title 5 of the California Code of Regulations require a one-year physical presence in the state of California prior to the first day of the term combined with one year of evidence of intent and ability to establish residency in California. Students may be required to present evidence regarding their residency. Some exceptions and limitations to the residency requirement exist; consult with the Admissions and Records Office. 24. Have you been in continuous residence in the state of California for at least the last two years? Yes No If NO, enter your last state or country of residence: State 25. When did your present (continuous) stay in California begin? Month / Day / Year 26. WITHIN THE LAST TWO YEARS, have you done any of the following OUTSIDE OF CALIFORNIA? Yes No If YES, check which you have done: Filed state income taxes in another state Voted in another state Petitioned for a divorce in another state Attended an out-of-state educational institution as a resident of THAT STATE Declared residency in ANOTHER STATE for income tax purposes MiraCosta College Application for Admission miracosta.edu

5 27. List any actions you have taken that might demonstrate your intent to be a California resident (such as obtaining California drivers license, identification card, voting in California, obtaining California vehicle registration, divorce in California, checking account, savings account, loan in California). Also, list date action was taken. 28. Are you a full-time employee or spouse or dependent of a full-time employee of a California community college, California State University or College, the University of California, or the Maritime Academy? Yes No If YES, list name, relationship, where employed and the position held: 29. Are you a full-time credentialed employee of a California public school enrolling in college for purposes of fulfulling credential-related requirements? Yes No 30. Have you been employed as a seasonal agricultural worker for at least a total of two months of each of the past two years? Yes No 31. Are you a dependent of your parents for income tax purposes? Yes No For the persons 18 years of age and under OR if you are the adult dependent child of a California resident, please answer questions 32 38: 32. Name and relationship of the parent with whom you are currently residing, or if no longer residing with a parent or guardian, the one with whom you last resided. Name: Relationship: If you live with someone other than a parent who is considered to be your guardian, please explain: 33. Citizenship Status of the parent or guardian listed above: U.S. Citizen Amnesty Permanent Resident Refugee/Asylee Temporary Resident Student Visa (F1/M1) DACA Other Status If you did not specify U.S. citizen, please indicate the following: CHECK IF NONE Alien Registration Number Or Visa Type Issue Date Expiration Date 34. Has your parent or guardian been in continuous residence in the state of California for at least the last two years? Yes No If NO, enter their last state or country of residence: State 35. When did your parent or guardian s present (continuous) stay in California begin? Month / Day / Year 36. Does your parent or guardian intend to maintain California as their state of legal residence? Yes No 37. WITHIN THE LAST TWO YEARS, has your parent or guardian done any of the following OUTSIDE OF CALIFORNIA? Yes No If YES, check which they have done: Filed state income taxes in another state Voted in another state Petitioned for a divorce in another state Attended an out-of-state educational institution as a resident of THAT STATE Declared residency in ANOTHER STATE for income tax purposes MiraCosta College Application for Admission miracosta.edu

6 38. List any actions your parent or guardian has taken that might demonstrate their intent to be a California resident (such as obtaining California driver s license, voted in California, California vehicle registration, California identification card, divorce in California, checking account, savings account, loan in California). Also, list date action was taken. 39. I understand the following information (please check each box): Federal and state financial aid programs are available to help with college costs including enrollment fees, books & supplies, transportation and room and board expenses. The application is available at fafsa.ed.gov. I may apply for and if eligible, receive financial assistance if I am enrolled, either full time or part time, in an eligible program of study (certificate, associate degree or transfer). Financial aid program information is available in the college financial aid office and at miracosta.edu/financialaid. WARNING: Falsifying information about citizenship, California residency, financial aid, and/or military status could result in: 1) criminal charges for perjury and/or fraud and, if convicted, imprisonment; 2) student disciplinary action; and/or 3) accumulated monetary charges such as for restitution or nonpayment of nonresident tuition fees. The information on this application is true and correct to the best of my knowledge. STUDENT SIGNATURE: DATE: FOR ADMINISTRATIVE USE ONLY Comments: Exception R Initials Derived R NR Self R NR The district, and each individual who represents the district, shall provide access to its services, classes, and programs without regard to age, ancestry, color, physical or mental disability, pregnancy, gender, gender identity, gender expression, marital status, medical condition, genetic information, national origin, parental status, race or ethnicity, religion, sexual orientation, military or veteran status, or because he or she is perceived to have one or more of the foregoing characteristics, or based on association with a person or group with one or more of these actual or perceived characteristics. MiraCosta College is accredited by the Accrediting Commission for Community and Junior Colleges, Western Association of Schools and Colleges, 10 Commercial Blvd., Suite 204, Novato, CA 94949, , an institutional accrediting body recognized by the Council for Higher Education Accreditation and the U.S. Department of Education. Additional information about accreditation, including the filing of complaints against member institutions, can be found at: The college is also approved by the California Department of Education for the training of veterans under the provisions of the G.I. Bill of Regulations. 10/15 MiraCosta College Application for Admission miracosta.edu