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First*Legal Name

Middle

Last*

Preferred Name

Social Security Number*The Social Security Number is not used as the Student Identification Number. Students will have a unique Student Identification Number assigned. Students should be aware that a correct Social Security Number must be on file for reporting information pertaining to potential tax credits, and must be used by applicants for federal and state aid. Failure to provide a correct Social Security Number may diminish student's opportunities for federal tax credits.

Street*Physical Address

Apt. No.

City*

State*

ZIP

Street or P.O. BoxMailing Address

Apt. No.

City

State

ZIP

Phone (Home)

Phone (Cell)

Email*

Verify Email

Preferred Contact Method*

home phone

cell phone

email

Date of Birth*

Gender*

Residency Determination

U.S. Citizen

Visa

DACA / Dreamer

These questions are asked for the purpose of determining tuition and fees. State law now requires that a person who is not a citizen or legal resident of the United States or who is without lawful immigration status is not entitled to classification as an in-state student pursuant to A.R.S. Section 15-1802 or entitled to classification as a county resident pursuant to A.R.S. Section 15-1802.01. Students will be classified as out-of-state for tuition and fee purposes until proper documentation is provided. The responsibility of registering under the proper residency classification is placed upon the student. Any student who falsifies his/her residency may be subject to dismissal from the College and/or criminal action. Refer to the College catalog for residency guidelines.

Visa Type and Country of Origin (if applicable)

Are you a legal Arizona resident?*

Yes

No

If yes, date present stay in AZ began

Most recent state of legal residence prior to moving to Arizona:

Month and year you left that state:

Arizona county of residence

Date you moved to this county?

High school graduate?*

Yes

No

High school name

State

Graduation Date

Prospective high school?

Yes

No

High school name

State

Graduation date

First Year You Plan to Attend*

Reason for Enrollment*

Employment Reasons

Transfer

Personal Interest or Self-improvement

Other

Undecided

Major Emphasis of Your Educational Program:

Transfer Degrees: AA (Associate of Arts) ABus (Associate of Business), AS (Associate of Science) or AGS (Associate of General Studies)

AAS Degree (Associate of Applied Science Degree)

Certificate of Completion (Occupational)

Uncertain

Not Seeking a Degree or Certification

Ethnicity*

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino

Race*

American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American - A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Other / None of the above

Select all that apply

Are you a United States Veteran?*

Yes

No

Do you give permission for the College to release directory information relative to your enrollment (as per the Family Educational Rights and Privacy Act of 1974)*

Yes

No

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