Minor Application Term* Spring Summer Fall Term Year* Legal Name* First Last Other Name: (if applicable) First Last Email* Phone*Name of high school* City/State/Country* Date Began (month/year)* When will you graduate from high school?* Home Address(Address where you reside in the US; do not use a P.O. Box)Street Address* Street Address 2 City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip/Postal Code* Is your Home Address also your Mailing Address?* Yes No Mailing Address(Address where you reside in the US; do not use a P.O. Box)Street Address* Street Address 2 City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip/Postal Code* Legal ResidenceCounty of Legal Residence*Atlantic CountyBergen CountyBurlington CountyCamden CountyCape May CountyCumberland CountyEssex CountyGloucester CountyHudson CountyHunterdon CountyMercer CountyMiddlesex CountyMonmouth CountyMorris CountyOcean CountyOut of StatePassaic CountySalem CountySomerset CountySussex CountyUnion CountyWarren CountyState of Legal Residence*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificSocial Security Number We are requesting your Social Security Number (SSN) for our system of student records as well as for compliance with federal and state reporting requirements. The College will not disclose your SSN to anyone outside the institution except as required by law, and will make every effort to protect your privacy. Date of Birth* Ethnicity* Hispanic/Latino Non Hispanic/Latino Gender* Female Male Race American/Alaska Native Asian Black or African American Hawaiian/Pacific Islander White Are you a U.S. citizen?* Yes No If you are not a U.S. citizen, what is your country of citizenship?* If you are not a U.S. citizen, are you a permanent resident of the United States?* Yes No If a permanent resident, what is your alien registration number?* If not a citizen or permanent resident, what type of status do you currently hold?* Is English your native language?* Yes No what is the language spoken at home?* Certification* I certify that:the above answers are true, correct, and complete to the best of my knowledge. If any statement is not true, I understand I will be held responsible. Further, I agree to abide by the rules and regulations of Camden County College as outlined in the College Catalog and the Student Handbook, and other College publications.Student's Signature*Student Name* Date* CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
