Admissions

Admission requested for:

Term you plan to enter SwCC:

NAME AND ADDRESS INFORMATION

First Name: Middle :

Last Name:

Date of Birth:
(MM/DD/YYYY) Gender:

Place of Birth City: State:

Demographic Information

Marital Status:

Ethnic Background:

Religious Preference:

Permanent Address

Street: Apt#

City: State: Zip:

E-Mail Address:

Perm Ph: Day Ph:

Current Address (if different from Permanent Address)

Street: Apt#

City: State: Zip:

Current Address good until: //20

Preferred Contact in the Event of an Emergency:

Day Ph: Evening Ph:

Relationship:

FAMILY INFORMATION

Guardian/Father's Name: Occupation:

Guardian/Mother's Name: Occupation:

Address: (not required if same as your address)

Street: Apt#

City: State: Zip:

EDUCATIONAL INFORMATION

Have you ever applied for admission to SwCC before? Date://

If you are reapplying to SwCC, give the date you last attended:
//

Your reason for withdrawal:

Housing Requirements:

Intended Major (if undecided please type "Liberal Arts"):

EDUCATIONAL BACKGROUND

High School Attended:

High School Address Street: City:
State: Zip:

Name of Counselor / College Advisor:
Tel.

Date of Graduation or Expected Date of Graduation:
//

Accumulative G.P.A. :

Class Rank: out of :

If you did not graduate from High School, do you have a GED?

List all Colleges at which you have taken Courses for Credit.
(College name, City, State, and Dates Attended)

High School or College Extracurricular, Personal and Volunteer Activities:

Honors and Outstanding Achievements

To What Other Colleges are you Applying?

SwCC ranks as your:

By typing my name and submitting this form, I affirm that all the information contained in my application is complete, factually correct and honestly presented.

Name: Date://20