APPLICATION FOR ADMISSION 1537 University Blvd., Morrilton, AR 72110 1-800-264-1094 www.uaccm.edu PERSONAL INFORMATION OFFICE USE ONLY I.D. 1. Last Name First Name Middle Int. Other Last Names Used 2. Social Security Number 3. Date of Birth 4. Address Apt. Number City State Zip County 5. Cell Phone Number 6. Home Phone Number 7. E-mail Address 8. Ethnicity (are you Hispanic or Latino?) 10. Gender Male Female 9. Race Black or African-American White Hispanic Asian American Indian or Alaskan Native Native Hawaiian or Pacific Islander Non-Resident Alien Unknown 11. Emergency Contact (Name) (Relationship) 12. Emergency Contact's Number 13. Do Either Of Your Parents Have A College Degree or Certificate? 14. May we contact you by text message regarding important enrollment information? 15. Are you a U.S. Veteran? RESIDENCY INFORMATION This section must be completed in its entirety or you will be charged out-of-state tuition. 16. U.S. Citizen? (If no, please indicate which you are) Permanent Resident Alien Arkansas Resident-not US Citizen Non-Permanent Resident International 17. Have you been a Legal Resident of Arkansas for more than 6 months? (Legal residency is the address used for all purposes including, but not limited to, voting, vehicle registration, tax assessment, and driver licensing.) (If yes, years/months) JUDICIAL INFORMATION Failure to answer these questions will delay the processing of your application. 18. Have you ever been convicted of a felony? (Convictions include a finding of guilty by a judge or jury, a plea of guilty, a plea of nolo contendere, or a plea of no contest, irrespective of whether an appeal or application for other relief is pending. Convictions also include juvenile adjudications.) 19. Are you a convicted sex offender or required to register as a sex offender? The existence of a conviction does not necessarily mean that a student will be denied admission to UACCM. However, your failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw your admission, or to dimiss you after enrollment. Each case will be individually evaluated and assessed on the facts of the conviction....continue ON NEXT PAGE
Application For Admission Continued ENROLLMENT INFORMATION 20. Enrollment Year 21. Enrollment Semester 22. Enrollment Status Fall (August) Spring (January) May Intersession Summer I Summer II New Freshman - I have never attended college (not counting college courses taken while in high school) Transfer Student - I attended another college prior to UACCM Readmitted UACCM Student - I attended UACCM previous (not counting college courses taken while in high school) High School Student - I will be taking college courses on the UACCM campus while I am still in high school Visiting Student - I plan to take less than 16 hours to meet an academic requirement at another institution. Visiting students are not eligible for financial aid and may not enroll in a course that requires a prerequisite until they have submitted official documentation that the prerequisite has met International Student EDUCATIONAL GOAL 23. Transfer Options (Basic) - Please check one of the boxes below if you plan to transfer. Associate of Arts/Associate of Science/Associate of General Studies Art Business Computer Information Science English General Education Health-Related History Psychology Sociology Science STEM (Pre-Engineering) Teaching: (K-6) Teaching: (Middle Level) Teaching: (Secondary Level 7-12) OR Career or Technical Options - Please check one of the boxes below if you plan to get to the workplace quickly AAS (Associate of Applied Science) (Max of 90 hours of financial assistance) TC (Technical Certificate) (Max of 48 hours for financial assistance except for PN students) CP (Certificate of Proficiency) (Do not qualify for federal financial aid) Air Conditioning, Heating & Refrigeration Technology AAS TC Automotive Collision Repair Technology AAS TC Automotive Services Technology AAS TC Business AAS (choose one option below) o Option: Accounting o Option: Business Office Technology o Option: Retail Marketing TC Computer Information Systems Technology AAS TC CP - Computer Maintenance CP - Networking Technology Crime Scene Investigation AAS TC CP I am a current Arkansas Law Enforcement Officer Drafting AAS TC Early Childhood Development AAS TC CP Emergency Medical Technician (EMT) CP Law Enforcement Administration AAS TC CP I am a current Arkansas Law Enforcement Officer Nursing Assisting CP Practical Nursing TC (Must be accepted into the program) Registered Nursing AAS (Must be accepted into the program) I am an LPN, LPTN, or LVN Petroleum Technology AAS TC CP Surveying AAS TC Welding TC CP - Pipe Welding (prior welding required) CP - Welding (Emphasis: Structural)...CONTINUE ON BACK
Application For Admission Continued ACADEMIC INFORMATION 24. Graduation Status Currently Attending High School: (Graduation Year) High School Graduate (Graduation Year) GED Diploma (Year) Did Not Finish High School/Do Not Have GED 25. Name of High School You Graduated From (City of High School) (State of High School) 26. Have You Attended UACCM/Petit Jean College Before? (Beginning Date) (Ending Date) 27. Reason for Enrolling at UACCM Complete Classes for Certificate/Degree Obtain or Improve Skills Self-Improvement/Personal Enrichment Other: 28. Name of Previous Colleges Attended Including High School Concurrent (please list all) State Dates Attended Credit Hours Earned Degrees Earned *Failure to submit accurate and complete information will result in financial aid delays. I hereby certify that all information supplied is complete and accurate. I understand that I shall not be considered for full or unconditional admission to UACCM until I have submitted all documentation specified. I understand that withholding information requested or giving false information may make me ineligible for admission and enrollment. I hereby give permission to UACCM to secure available on-line documents required for admission to the college including shot records and transcripts. I agree to abide by all UACCM policies, including, but not limited to, the Student Code of Conduct. I understand that to be eligible for enrollment at any public institution of higher education within the State of Arkansas, I must register, or be exempt from registration, with the Selective Service system as specified in Act 228 of the 1997 Arkansas General Assembly. I swear or affirm under penalty of perjury that I have registered with the Selective Service System, or I am exempted from such registration. 29. Signature: Date: STATEMENT OF ASSURANCE: UACCM assures that no person shall, on basis of race, color, national origin, age, sex, or disability, be excluded from participation in or be subjected to discrimination under any program activity. UACCM, in making decisions regarding student admissions and other functions and operations, adheres to a policy of non-discrimination.
Checklist ADMISSION REQUIREMENTS FULL-TIME/PART-TIME STUDENTS (SEEKING A CERTIFICATE OR AN ASSOCIATE DEGREE) *1. Complete a UACCM Application for Admission. Located on pages 4, 5 and 6 or online at www.uaccm.edu. *2. Provide results of ACT or COMPASS testing. Scores are used to determine placement in English, reading, and math. Visit the Testing Services page at www.uaccm.edu for more information about when tests are given. A $15 COMPASS test fee is required. ACT and COMPASS scores are valid for 5 years. *3. Provide a copy of high school transcript or GED scores. Must be an official high school transcript with a stamped school seal or General Educational Development (GED) scores. Please request that the institution mail the transcript directly to UA Community College at Morrilton, 1537 University Blvd., Morrilton, AR 72110. (If transcript is in a maiden name, please ask high school to indicate your current last name on form.) 4. Provide shot record. Arkansas State Law requires all students, to provide proof of immunity against measles, mumps, and rubella. Students born on or after January 1, 1957 must have proof of two measles immunizations, one mumps immunization, and one rubella immunization. *These documents needed prior to admission and receipt of financial aid. See the College Catalog for additional details. TRANSFER STUDENTS Note: Students transferring from another college or university must provide the following documents in addition to the requirements above. *5. Provide an official transcript from all colleges attended including high school concurrent. Transfer applicants should submit an official transcript from all colleges attended. Please request that the institution mail the transcript directly to UA Community College at Morrilton, 1537 University Blvd., Morrilton, AR 72110. (If transcript is in a maiden name, please ask college to indicate your current last name on form.) Students who have successfully completed 15 college-level credit hours are not required to submit a high school transcript. *These documents needed prior to admission and receipt of financial aid. VISITING STUDENTS (NOT SEEKING A CERTIFICATE OR AN ASSOCIATE DEGREE) 1. Complete a UACCM Application for Admission. Located on pages 4, 5 and 6 or online at www.uaccm.edu. 2. Complete a Visiting Student Form. 3. Provide proof of pre-requisites. Note: Visiting Students are not eligible for financial aid. When a Visiting Student has completed a total of 16 credit hours or wishes to enroll in courses which will cause him/her to exceed 16 credit hours, he/she is no longer eligible to enroll in a visiting status. Prior to enrolling in courses which exceed the 16 hour limit, the student must complete all of the General Admission Requirements and be admitted to the College. After being admitted to the College, these students will be assigned an academic advisor and may continue to take courses without pursuing an award. Check your admission status any time by logging on to CampusConnect using your UACCM student ID number. You may also view your bill, check course availability, and print your schedule. Note: Must use "Login" button Check our website for Admission Requirements for Nursing, High School Concurrent, and International Students.
ADMISSION TESTING The Computerized Adaptive Placement, Assessment, and Support System (COMPASS) Test is a college entrance exam which helps place students in appropriate courses. Testing is available each Tuesday through Friday. For detailed test information, including available testing times, go to www.uaccm.edu and select Testing Services from the site index. UACCM S OFFICE OF TESTING SERVICES OFFERS THE COMPASS TEST FOUR DAYS A WEEK. MON TUES WED THURS FRI JUNE-JULY NO TEST 2:30 pm 2:30 pm 4:30 pm 11:00 am Check Website Testing Services hours are subject to change. Please check the UACCM website for updated testing schedule. REMEMBER THE FOLLOWING: No appointment necessary. COMPASS testing is on a first-come, first-served basis subject to space availability. There is a $15 non-refundable, non-transferrable fee to take the test. Pay at the Student Accounts window in the University Center prior to testing. Retests are $5 per section. Photo ID is required (driver s license, state ID, passport, or UACCM student ID card). Calculators up to TI-84 may be used. The COMPASS is not timed; however, Testing Services closes two hours after the times listed above. Students are responsible for arriving with adequate time to complete the test. The COMPASS test has three sections: writing, reading, and math. You can take the test multiple times, and UACCM will use your highest score from each section for placement purposes. More information can be found at www.uaccm.edu/ future_student/testing_services.htm. TEST-TAKING HELP SITES www.act.org/compass - Sample COMPASS test questions www.testprepreview.com - Sample test questions www.khanacademy.org - Online-tutorials IMPROVE YOUR TEST SCORES UACCM wants you to be successful... That s why we are offering two FREE options to help you improve your test scores. OPTION 1 OPTION 2 TEST IMPROVEMENT PROGRAM SESSIONS (TIPS) This program is computer-based and self-paced. Math and English coaches are available to assist you. Location: Academic Commons/E. Allen Gordon Library UACCM Library Complex 1537 University Blvd., Morrilton, AR 72110 501-354-7560 ADULT EDUCATION Adult Education does more than just offer GED classes. Free tutoring is also available to help you improve your skills in English, math, and reading. Please note that the services are only available when you are not currently in high school or taking college classes. Location: UACCM Community Education Center 600 North Saint Joseph Street, Morrilton, AR 72110 501-215-4904 OTHER ADULT EDUCATION CENTERS IN THE AREA Conway Adult Education Center - 501-450-4810 Russellville Adult Education Center - 479-968-5244 Clinton Adult Education Center - 501-745-6554