PERSONAL INFORMATION
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?)
Yes
No9. Race
Black or African-American
White
Hispanic
Asian
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
Non-Resident Alien
Unknown 10. Gender
Male
Female11. Emergency Contact (Name) (Relationship) 12. Emergency Contact's Number
13. Do Either Of Your Parents Have A College Degree or Certificate?
Yes
No14. May we contact you by text message regarding important enrollment information?
Yes
No15. Are you a U.S. Veteran?
Yes
No OFFICE USE ONLYI.D. __________________________
APPLICATION
FOR ADMISSION
1537 University Blvd., Morrilton, AR 72110 1-800-264-1094 | www.uaccm.edu
RESIDENCY INFORMATION
This section must be completed in its entirety or you will be charged out-of-state tuition.
16. U.S. Citizen?
Yes
No(If no, please indicate which you are)
Permanent Resident Alien
Non-Permanent Resident
Arkansas Resident-not US Citizen
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.)
Yes
No(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.)
Yes
No19. Are you a convicted sex offender or required to register as a sex offender?
Yes
NoThe 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
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Application For Admission Continued
ENROLLMENT INFORMATION
20. Enrollment Year 21. Enrollment Semester
Fall (August)
Spring (January)
May Intersession
Summer I
Summer II 22. Enrollment Status
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 StudentEDUCATIONAL 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
TCAutomotive Collision Repair Technology
AAS
TCAutomotive Services Technology
AAS
TCBusiness
AAS (choose one option below)
Option: Accounting
Option: Business Office Technology
Option: Retail Marketing
TCComputer 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
TCEarly Childhood Development
AAS
TC
CPEmergency Medical Technician (EMT)
CPLaw 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 LVNPetroleum Technology
AAS
TC
CP Surveying
AAS
TC Welding
TC
CP - Pipe Welding (prior welding required)
CP - Welding (Emphasis: Structural)...CONTINUE ON BACK
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.
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 GED25. Name of High School You Graduated From (City of High School) (State of High School)
26. Have You Attended UACCM/Petit Jean College Before?
Yes
No(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.
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 our website for Admission Requirements for Nursing, High School Concurrent, and International Students.
Checklist
Note: Must use "Login" button
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.
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.
WED
8:30 am-
2:30 pm
MON
NO TEST
