Admissions Application

Admissions

Application

Pamlico Community College

Post Office 185

Grantsboro, North Carolina 28529

(252) 249-1851

www.pamlicocc.edu

Application for Admission

INSTRUCTIONS: Complete the form in full and mail to the above address or email to [email protected]. Answer “ALL” questions completely and accurately. Incomplete forms may delay your acceptance. Information supplied will be confidential. High school and college transcripts are required for all students except Special Credit students.Please verify that your program of study is accurate. Failure to do so could negatively impact your Financial Aid.

PLEASE PRINT ALL INFORMATION Social Security No.:

Last Name: First Name: Middle/Maiden Name: Mailing Address: City: State: Zip: Email Address:

Home Phone No.: ( ) Business Phone No.: ( ) County of Residence:

Highest Grade Completed:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Sex: Male Female Birthdate: / /

Ethnic Origin: 1. White 2. Black 3. Am. Indian 4. Hispanic 5. Asian 6. Other

I plan to enroll: Day Evening

I plan to enroll as a Full-time Part-time student. (12 credit hours or more is full-time)

I plan to enroll Fall Spring Summer 20 _______

Select Your Major from the list on the next page and enter the corresponding 6-digit code. For example, if your major will be Business Administration, enter:

A25120

Example Only—Choose your code from page 6

** ENTER MAJOR CODE

If you are not seeking a degree, diploma or certificate, check “Special Credit” below:

SPECIAL CREDIT:

Employment Status:

Retired Employed 1-10 hrs/week

Unemployed Employed 11-20 hrs/week

(Not seeking employment) Employed 21-39 hrs/week

Unemployed Employed 40 + hrs/week

(Seeking employment)

Long Term Goal: (choose one) Focus On Success:

PCC’s First Year Student Program(check all that apply) 1. To obtain an Associate Degree, Diploma or Certificate 1. I have never attended college before.

2. To enhance my skills in my present field of work 2. I have not attended college in 5 or more years. 3. To enhance my skills for a new field of work 3. I have less than 12 college course credits. 4. To take courses to transfer to another college

5. To take courses for personal enrichment or interest Are you currently enrolled in high school? Yes No High School Attended:

City: ___________________ State:

From: Month: Year: To: Month: Year: _____

Years of Education Completed:

Non-Graduate (please indicate highest grade completed): _____________ High School Graduate If YES, date of graduation: Month: _________ Year: ______ Adult High School Diploma GED

Issuing Agency: ____________________________ State: ___________ Month: ___ Year: ______ Post High School Vocational Diploma

Associate Degree Bachelor’s Degree Master’s Degree or Higher

Have you enrolled at PCC before?

If YES, what program? _________________________________ Dates: ______________________________________________

Colleges Attended: Name of College, City, State, Dates, and Degree Received (Must list here if any):

FINANCIAL AID:

I am applying for: WIA Scholarship Social Security V.A. Benefits Vocational Rehabilitation (N.C.) Federal Pell Grant Federal Work Study

EMERGENCY INFORMATION:

Family Physician:

NAME ADDRESS PHONE

Person to Contact In Case of Emergency:

NAME ADDRESS PHONE RELATIONSHIP

Permission is granted to call the family physician (or a physician of the school’s choice if family doctor is not available) in the case of emergency or medical necessity. Yes No

STUDENT COMMENTS:

What brought PCC to your attention? Radio, Newspaper, High School Counselor or Teacher, PCC Student, Catalog, or Brochure, Other:

Is there someone you know who would benefit from information about Pamlico Community College?

Name: Name:

Address: Address:

Phone: _________________ Program/Interest: Phone: __________________ Program/Interest:

I certify that the information that I have provided on this application is accurate to the best of my knowledge, and I agree to observe all rules and regulation of Pamlico Community College. I further agree to allow PCC to publish personal information pertaining to honor rolls, scholarships, news releases, and to use personal information in other publications normally considered to be that of a two-year college. All students enrolling in PCC shall be deemed to have agreed to publications of personal data as indicated above unless a disclaimer is filed with the Vice President of Student Services by the 10

th

day of the semester in which the initial enrollment is made.

Signature of Student:

Date:

Signature of Parent or Guardian (if applicant is under 18):

Date:

DISPOSITION

Accept , Hold , 20 ____ for: Fall , Spring , Summer

COMMENTS:

STUDENT STATUS

Resident Non-Resident Foreign

Name of State Name of Country

Refer to Committee:

___________________________________________

SIGNATURE

__________________________________________

TITLE DATE

INSTRUCTIONS FOR ADMISSION

No deposit is required with the application

To be fully admitted to a curriculum program of Pamlico Community College, applicants must be a high school graduate or

the equivalent (GED or Adult High School Diploma).

1. Complete the Transcript Request form and send to your high school, GED Center, and all colleges you have

attended. (Special credit applicants taking courses are not required to submit transcripts). Official transcripts from

each college must be mailed directly to PCC.

2. The applicant should call and schedule a personal interview with a counselor after completing the application,

requesting high school and/or college transcripts, and taking a placement test. (252) 249-1851 Ext. 3014

3. All applicants are required to fill in the Residency Status Form below.

4. VA and other Financial Aid applicants should call and schedule a personal interview with a counselor.

(252)249-1851 Ext. 3023

5. If additional information is needed, the applicant will be notified.

RESIDENCY STATEMENT

North Carolina statute (G.S. 1166-143.1) requires that “To qualify as a resident for tuition purposes, a person must have

established a legal residence in North Carolina and maintained that legal residence for at least 12 months immediately

prior to his or her classification as a resident for tuition purposes.” Copies of the applicable law and of implementing

regulations are available for inspection in the office of the Dean of Students and may be examined upon request.

THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS

1. State of Legal Residence:

Place of Birth: (City) __________________________________ (State)

2. Have you maintained your residence in North Carolina for at least twelve (12) months immediately prior to

the date of this application?

Yes

No

3. Filed N.C. State income tax?

Yes

No

Years:

Registered to vote in N.C.?

Yes

No

County:

Motor Vehicle registered or licensed in N.C.?

Yes

No

Have N.C. drivers’ license?

Yes

No

4. Have you ever lived outside N.C.?

Yes

No

If yes, for what purposes? Military Service _____ Employment ______ Other

5. List previous address of out-of-state residence:

Please verify that your program of study is accurate. Failure to do so could negatively impact your Financial Aid.

CURRICULUM MAJORS

Name

SS#:

STARTING SEMESTER:

COLLEGE CAREER PROMISE PATHWAYS

Humanities and Social Science ... P1012A Business and Economics ... P1012B Life and Health Sciences ... P1042A Business Administration ... C25120H1 Business Administration Diploma ... D25120H1 Computer Information Technology Diploma ... D25260H1 Computer Information Technology Certificate ... C25260H1 Computer Information Technology Certificate ... C25260H2 Cosmetology Pathway ... D55140H1 Criminal Justice Pathway ... D55180H1 Early Childhood Education Pathway ... D55220H1 Electrical/Electronics Technology Diploma Pathway ... D35220H1 Electrical/Electronics Technology Certificate ... C35220H1 Environmental Science Technology Pathway ... D20140H1 Medical Assisting Pathway ... D45400H1 Medical Assisting Pathway ... D45400H2 Medical Office Administration Pathway ... D25310H1 Welding Technology Pathway ... D50420H1

We must report the number of students we serve who fall into various categories. A good portion of our Federal and State

funding depends on this information. Please take a minute and complete the questionnaire below. Your cooperation is

greatly appreciated.

If ANY of the following apply to you please check:

(H)

Hard of Hearing

Orthopedically impaired

(D)

Deaf/hearing impaired

Visually impaired

(S)

Speech impaired

Learning disability

(X)

Other handicap, please

Explain

If ANY of the following apply to you please check:

A Single parent with the responsibilities for a child/children

Displaced homemaker(someone who must prepare for paid employment because of a divorce,

separation or the death or disability of a spouse).

I live in a home where a language other than English is spoken most of the time.

My native language is NOT English.

I have difficulty with reading, writing and/or mathematical skills.

High School dropout (with or without GED)

Receives some type of public assistance (AFDC, Food Stamps, etc)

None of the above