Application for Enrollment and Instructions

Application for Enrollment and Instructions Apply online at www.ccri.edu/oes/admissions/learnhowtoapply.html or follow the instructions below to apply by mail. Personal data section Your Social Security number and date of birth are essential in processing your application. Your Social Security number is mandatory under federal law. Under permanent address, list the street, city, state, and zip code of your legal residence. This is where most major correspondence will be sent, unless you later notify the Office of Enrollment Services that you prefer materials be sent to a different address. Please be sure to print clearly. Please note that if you are not a U.S. citizen, you may be asked to submit immigration documentation as listed on the Application for Enrollment. Foreign students must contact the Office of Enrollment Services regarding visas and additional admissions documentation which is required for attendance at the college. Questions pertaining to ethnicity and race are optional; however, answering these questions is important in assisting the college in its affirmative action goals. Programs of interest section For campus codes and program names, refer to pages 2 through 4 of this application packet. High school history section For high school codes, refer to page 5 of this packet. It is the applicant s responsibility to provide the Office of Enrollment Services with official transcripts. Contact your high school guidance department or GED testing center to forward official transcripts or GED scores to the college. College history section List ALL colleges and universities previously attended, whether or not you wish to receive transfer credit. For your convenience, some college codes are listed on page 5 of this packet. If your institution is not listed, do not enter a college code on the application. Payment of application fee If using a paper Application for Enrollment, please sign and return your application along with all required documents and the $20 non-refundable application fee to the campus of your choice. In Lincoln: In Warwick: CCRI-Flanagan Campus CCRI-Knight Campus Office of Enrollment Services Office of Enrollment Services 1762 Louisquisset Pike 400 East Ave. Lincoln, RI 02865-4585 Warwick, RI 02886-1807 In Providence: CCRI-Liston Campus Office of Enrollment Services One Hilton St. Providence, RI 02905-2304 In Newport: CCRI-Newport CountyCampus Office of Enrollment Services One John H. Chafee Blvd. Newport, RI 02840

Degree and Certificate Programs* PROGRAM CODE DEGREE CAMPUS DAY EVENING ADMINISTRATIVE OFFICE TECHNOLOGY Administrative Assistant/Secretary ADAD A.S. KN FL + + Basic Office Skills Certificate BOSC Certificate PV KN FL + + Customer Service Specialist Certificate CSPC Certificate KN FL + + Culinary Arts Assistant Certificate CULN Certificate FL + + Legal Administrative Assistant/Secretary LGAD A.S. FL + + Legal Office Assistant Certificate LOAC Certificate FL + + Medical Administrative Assistant/Secretary MDAD A.S. KN + Medical Insurance Billing Specialist Certificate MIBC Certificate KN + + Medical Transcription Certificate MEDT Certificate KN + Office Administration Certificate OFAC Certificate PV KN FL + + Travel, Tourism and Hospitality Certificate TRVL Certificate KN + + BIOTECHNOLOGY Biotechnology Certificate BIOT Certificate KN + BUSINESS ADMINISTRATION Accounting ACCT A.S. KN FL + + Accounting Certificate ACTC Certificate KN FL + + Entrepreneurship Certificate ETRC Certificate KN FL + + Financial Services FNBK A.S. KN FL + + Financial Services Certificate FNSC Certificate KN FL + + General Business GBUS A.S. KN FL PV NE + + Management MNGT A.S. KN FL + + Management Certificate MGTC Certificate KN FL + + Marketing MARK A.S. KN FL + + Marketing Certificate MRKC Certificate KN FL + + CHEMISTRY Chemical Technology CHMT A.A.S. KN + + Chemical Technology Certificate CHMC Certificate KN + + COMMUNICATION New Media Communication Certificate NMCC Certificate KN FL PV NE + + COMPUTER STUDIES and INFORMATION PROCESSING Computer Programming CPRD A.S. KN + + Computer Science RIC Track CRIC A.S. KN + + Computer Science URI Track CURI A.S. KN + + Computer Programming Certificate CPCT Certificate KN + + General Microcomputing CMGD A.S. KN + + General Microcomputing Certificate CMGC Certificate KN + + Information Technology Support Specialist CMSD A.S. KN + + Information Technology Support Specialist Certificate CMSC Certificate KN + + Networking CMND A.S. KN + + KN=Knight Campus FL=Flanagan Campus PV=Providence Campus NE=Newport County Campus A.A.=Associate in Art A.S.=Associate in Science A.A.S.=Associate in Applied Science A.F.A.=Associate in Fine Arts A.A.S.T.S.=Associate in Applied Science in Technical Studies ^ Some, but not all, major courses offered on this campus. CCRI APPLICATION INSTRUCTIONS / PAGE 2 OF 7 8/2013

Degree and Certificate Programs* PROGRAM CODE DEGREE CAMPUS DAY EVENING Computer Computer Studies and Studies Information and Information Processing Processing (continued) (continued) Networking Certificate CMNC Certificate KN + + Office Automation Certificate (Word Processing) OFFA Certificate KN + + Web Technologies CWTD A.S. KN + + Web Technologies Certificate CWTC Certificate KN + + ENGINEERING and TECHNOLOGY Advanced Networking Technician Certificate NWAC Certificate KN + + CNC Manufacturing and 3D-Modeling Certificate 1ETCA Certificate KN + Computer Desktop Technician Certificate CDTC Certificate KN + + Computer and Networking Technology CNTD Computer Desktop Technology Track CDTO A.A.S. KN + + Computer Networking Technology Track CNTO A.A.S. KN + + Energy Utility Technology Certificate ETUT Certificate KN + + Engineering Systems Technology ETST A.S. KN + + Engineering Transfer ENGN A.S. KN + + Introduction to CNC Manufacturing Certificate ETCI Certificate KN + Land Surveying Technology (program under revision) LAND A.A.S. KN + + Networking Technician Certificate NWTC Certificate KN + + FINE ARTS Art ARTS A.F.A. PV KN FL NE + + Theatre Performance Track DRAM A.F.A. KN FL + Technical Track TDRA A.F.A. KN FL + Jazz Studies JAZZ A.F.A. KN + Music MUSC A.F.A. KN + GENERAL STUDIES General Studies GENS A.A. PV KN FL NE + + HEALTH SCIENCES ALLIED HEALTH PROGRAMS Clinical Laboratory Technology CLAB A.A.S. FL + Diagnostic Medical Sonography DMSD A.A.S. FL + + Histotechnician HSTO A.A.S. PV + + Magnetic Resonance Imaging Certificate MRIC Certificate PV + + Phlebotomy Certificate PHLE Certificate PV + + Radiography (X-ray) XRAY A.A.S. FL + Renal Dialysis Technology Certificate RENL Certificate PV + Respiratory Therapy RESP A.A.S. FL + DENTAL HEALTH PROGRAMS Dental Assisting Certificate DAST Certificate FL + Dental Hygiene DHYG A.A.S. FL + EMERGENCY/DISASTER MANAGEMENT Emergency Management EMGD A.S. KN FL PV NE + Emergency/Disaster Management Certificate EMER Certificate KN FL PV NE + Fire Science FIRE A.A.S. KN FL PV NE + + Homeland Security Certificate HMLS Certificate KN FL + + CCRI APPLICATION INSTRUCTIONS / PAGE 3 OF 7 8/2013

Degree and Certificate Programs* PROGRAM CODE DEGREE CAMPUS DAY EVENING Health Sciences Health (continued) Sciences (continued) NURSING PROGRAMS Nursing NURS A.S. or Diploma KN PV FL NE + + Health Care Interpreter Certificate INTC Certificate PV + REHABILITATIVE HEALTH PROGRAMS Occupational Therapy Assistant OCTA A.A.S. NE + Opticianry OPTI A.A.S. DL/NE + Physical Therapist Assistant PHTA A.A.S. NE + Therapeutic Massage TMSG A.A.S. NE + Therapeutic Massage Certificate TMSC Certificate NE + HOSPITALITY Travel, Tourism and Hospitality Certificate TRVL Certificate KN + + Culinary Arts Assistant Certificate CULN Certificate FL + + HUMAN SERVICES Early Childhood Education and Child Development CHLD A.A. KN FL + Developmental Disabilities Certificate CDVD Certificate KN FL + Early Childhood Education Certificate CHLC Certificate KN FL + Education/Special Education ESPE A.A. KN FL + Social Service Majors: Gerontology GERN A.A. KN FL + Mental Health MNTL A.A. KN FL + Social Work SOWK A.A. KN FL + Substance Abuse SUBS A.A. KN FL + Social Services Certificate CSOS Certificate KN FL + LEGAL STUDIES Law Enforcement LENF A.S. PV KN FL NE^ + + Paralegal Studies PALG A.S. PV KN FL NE^ + + LIBERAL ARTS Liberal Arts LIBA A.A. PV KN FL NE + + Liberal Arts English LAEN A.A. KN FL + + Liberal Arts Foreign Languages LAFL A.A. KN FL + + Liberal Arts Mathematics LAMA A.A. KN FL + + Liberal Arts Psychology LAPS A.A. KN FL + + SCIENCE Science SCID A.S. KN FL + + TECHNICAL STUDIES Technical Studies TECH A.A.S.- T.S. KN FL + + *Programs are subject to change at any time. CCRI APPLICATION INSTRUCTIONS / PAGE 4 OF 7 8/2013

High School and College Codes High School Codes Academy for Career Exploration...400146 (formerly Textron Chamber of Commerce Academy) Alternate Learning Project...400143 Dr. Jorge Alvarez High School...400001 Apponaug Christian Academy...400241 Aquidneck Island Christian Academy...400129 Attleboro High School...220073 Barrington Christian Academy...400002 Barrington High School...400000 Beacon Charter School...400282 Bellingham Memorial Jr.-Sr. High School...220117 Bishop Connolly Regional High School...220783 Bishop Feehan High School...220077 Bishop Hendricken High School...400238 Bishop Keough Regional High School...400099 Blackstone Academy Charter School...400100 Blackstone-Millville Regional High School...220160 Blackstone Valley Baptist Academy...400038 Blackstone Valley Reg. Voc. Tech. High School...222154 Block Island High School...400005 Burrillville High School...400055 Case High School...222105 Central Falls High School...400012 Central High School...400145 Chariho High School...400270 Classical High School...400150 Convent of the Sacred Heart...409001 Coventry High School...400030 Coyle-Cassidy Memorial High School...222120 Cranston High School East...400035 Cranston High School West...400036 Paul Cuffee High School...400006 Cumberland High School...400037 Davies Career and Technical High School...400057 Dighton-Rehoboth Regional High School...221645 Durfee High School...220785 E 3 Academy...400157 East Greenwich High School... 400040 East Providence High School... 400050 Elmhurst Academy... 409003 Exeter-West Greenwich Regional Jr.-Sr. High School...400252 Feinstein High School...400154 First Baptist Christian School...400242 Fletcher Preparatory...409004 Foxborough High School...220840 GED...409999 Global Learning Public Charter School...221488 Greene School...400254 Hope High School...400155 Immaculate Conception Academy...400227 Johnston High School...400058 Killingly High School...070135 King Phillip Regional High School...222562 La Salle Academy...400160 Lincoln High School...400059 Lincoln School (Providence)...400165 Mansfield High School...221320 Masters Regional Academy...400220 The Metropolitan Regional Career and Technical Center...400166 Middletown High School...400063 Milton High School...221440 Moses Brown School...400180 Mount Hope High School (formerly Bristol High School)...400010 Mount Pleasant High School...400185 Mount St. Charles Academy...400285 Narragansett High School...400064 New England Academy of Torah (Hebrew Day)...400187 New England Laborers /Cranston Public School Construction Academy...400034 North Attleboro High School...221625 North Kingstown High School...400088 North Providence High School...400090 North Smithfield High School...400287 Norton High School...221670 Ocean Tides School...400066 Our Lady of Fatima High School...400236 Pilgrim High School...400239 Plainfield High School...070090 Ponaganset High School...400093 Portsmouth High School...400128 Portsmouth Abbey School...400130 Paul J. Primavera Educational Center...220116 The Prout School...400228 Providence Career and Technical High School...400142 Providence Country Day School...400045 Rhode Island School for the Deaf...400189 Rocky Hill School...400043 Rogers High School...400075 Juanita Sanchez Complex...400183 (formerly the Providence Academy of International Studies and William Cooley Health, Science and Technology Academy) School One...400188 Scituate Jr.-Sr. High School...400095 Seekonk High School...221891 Shea High School (Pawtucket West)...400125 Smithfield High School...400053 South Kingstown High School...400230 St. Andrew s High School...400250 St. Dunstan s Day School...400193 St. George s High School...400085 St. Mary Academy (Bay View)...400215 St. Raphael Academy...400110 Taunton High School...222123 Times 2 Academy...400144 Tiverton High School...400224 Tri-County Reg. Voc. Technical High School...220864 Trinity Christian Academy...400060 Toll Gate High School...400237 Tolman Senior High School...400115 U.S. Naval Academy Prep School...400068 Uxbridge High School...222155 Jacqueline M. Walsh School of Performing and Visual Arts...400969 Warren High School...400235 Warwick Veterans High School...400240 West Warwick High School...400265 Westerly High School...400255 The Wheeler School...400170 Woonsocket High School...400295 Other...409666 Out-of-Country...409777 Out-of-State (if not listed above)...409888 College Codes Bridgewater State University... 3517 Bristol Community College... 3110 Bryant University... 3095 Community College of Rhode Island... 3733 Dean College... 3352 Fisher College... 3391 Johnson & Wales University... 3465 New England Institute of Technology... 0339 Providence College... 3693 Rhode Island College... 3724 Roger Williams University... 3729 Salve Regina University... 3759 University of Massachusetts-Dartmouth... 3786 University of Rhode Island... 3919 CCRI APPLICATION INSTRUCTIONS / PAGE 5 OF 7 8/2013

CCRI ID Number: For Office Use APPLICATION FOR ENROLLMENT $20 (Application fee) Tell us about your interest in CCRI. Please share this information with us so that we can better advise you on your best course of action at CCRI. First time in college. I have not attended college previously. Readmit. I previously attended CCRI. Nondegree. I am enrolled at another college or university, taking classes at CCRI, but not pursuing a degree at CCRI; or I am interested in taking courses for personal or professional reasons. Transfer. I am entering CCRI and I have previous college-level coursework. Dual enrollment. I am currently in high school and I meet the requirements as stated in the college catalog to pursue college courses. Personal data: Complete this form after you have reviewed our program listings. Please print clearly. Date of application Name as it appears on Social Security card or U.S. passport Social Security number Mandatory for financial aid or federal education tax credit (1098-T form). It will not be used as a student ID. Last name First name Middle initial Date of birth (mm/dd/yy) Previous/Maiden Name Last name First name Middle initial Permanent home street address Gender: Male Female City State ZIP Home telephone number Cell number E-mail address Have you lived continuously in Rhode Island for one or more years as of the date of this application? Are you a U.S. citizen? Is Rhode Island your legal and permanent state of residence? If you have a non-rhode Island permanent home address and you are claiming Rhode Island residency, you must submit a CCRI Application for In-State Residency and all required documentation. This information is available at www.ccri.edu/oes/forms/residencyappealletter.pdf If you are not a legal and permanent resident of Rhode Island, please list your legal residence. Street City State ZIP Country Are you in the armed forces (or a dependent) currently stationed in Rhode Island? If yes, please send a copy of the current military orders with assignment to Rhode Island to the Office of Enrollment Services. Will you be using military benefits at CCRI? Will you be using military benefits as a dependent at CCRI? Veteran ID number (Veteran ID number is the Social Security number of the veteran benefit holder.) Please note: U.S. Permanent Residents must mail a copy of both sides of the Permanent Resident Card. Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must mail a copy of the documentation of their status. Other visa or immigration status: Please mail a copy of your Visa, I-797 or other documentation. Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college, but you will remain liable for all tuition and fees. The following information helps us comply with federal statistical reporting requirements only and will not, in any way, impact an admission decision on your application. Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories. Ethnicity: (Not used for admission. Please check one.)* Not Hispanic Hispanic or Latino Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories Race: (Not used for admission. You may check more than one race.) American Indian or Native American Asian Black or African American Native Hawaiian or Pacific Islander White Important information: One or both parents (biological or adoptive) earned a four-year degree Single parent with custody of a child under 18 Speaker of English as a second language Displaced homemaker * Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education reporting purposes. Only statistical numbers are reported. No individual data appears on the federal reports. The term displaced homemaker refers to women or men who have worked mainly in the home for a minimum of two years caring for home and family. Due to loss of family financial support (usually through death, disability or divorce), these individuals must leave the home and seek to support themselves and their families. For Office Use

Programs of interest: Please indicate your program choices. Please print clearly. What program of study are you interested in pursuing? I am interested in a degree program 1st choice Campus Program of study name 2nd choice Campus Program of study name At this time, I am interested in applying as a nondegree student (Please note: Financial aid, including on-campus work programs, is not available to nondegree students.) Intended Entry Date January/Spring September/Fall Summer Year Are you interested in receiving information about the Joint Admissions Agreement (JAA) among the Community College of Rhode Island, Rhode Island College and the University of Rhode Island?, thank you High school history: Please complete as appropriate. Please print clearly. I have or will have: High school diploma Diploma Date Institution name, city, state Code Month / Day / Year GED credential Date Received State in which GED credential was received Code Month / Day / Year Home school diploma Please submit documentation from your local school district approving your home schooling program. Date Received Institution name, city, state Code Month / Day / Year I do not hold any of the above. Please forward a copy of your final official high school transcript or GED credential to the Office of Enrollment Services as soon as available. College history: Please list ALL undergraduate colleges and universities attended. (Please submit official transcripts from each school to the Office of Enrollment Services, 1762 Louisquisset Pike, Lincoln, RI 02865.) Please print clearly. Do you have a bachelor s degree from a U.S. college or its equivalent from a school in another country? If yes, indicate the degree received below. COLLEGE 1: College/University name Code City State Degree COLLEGE 2: College/University name Code City State Degree COLLEGE 3: College/University name Code City State Degree Agreements: I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to abide by the rules and regulations at, and fulfill all financial obligations to, the Community College of Rhode Island. For Office Use Only Applicant's signature Application date Fee paid $ Method of payment (check one) for the $20 fee. Check or money order enclosed. Credit card payment: If paying by credit card, you must submit payment in person at the bursar s office on any CCRI campus. NEBHE CCRI APPLICATION 9/2012