Fillable APPLICATION FOR ADMISSION (Bishop State Community College)

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APPLICATION FOR ADMISSION (Bishop State Community College)

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APPLICATION FOR ADMISSION
admiss@bishop.edu
Main Campus Carver Campus Central Campus Southwest Campus
ENTRANCE INFORMATION
Applying for: Admission Readmission Term of Enrollment: Fall Spring Summer Year _____________
ANTICIPATED MAJOR COURSE OF STUDY
Major ____________________________________________________________________ Degree: AS AA AAS AOT CER STC
PERSONAL INFORMATION
Social Security Number________________________________________ Email Address_______________________________________________
Student Name (First, Middle, Last)___________________________________________________________________________________________
Mailing Address_______________________________________________ City ___________________________ State _______ Zip ____________
Home Phone (_____) _______________ Cell Phone (_____) ________________ Previous name(s) used____________________________________
Permanent Address if different from above:_____________________________________________________________________________________
Alabama Resident: Yes No State of Residence _______ County_______________________ Country of Birth _________________________
In case of emergency, notify: Name ____________________________________________________ Phone (_____)__________________________
BACKGROUND INFORMATION FOR REPORTING USE ONLY
The Department of Health, Education and Welfare and other federal agencies require this information
Ethnicity: Asian White Hispanic/Latino Black American Indian/Alaskan Native Native Hawaiian/ Pacific Islander Other
Date of Birth: ________/________/________ Sex: Male Female Marital Status: Married Single
Citizenship: U.S. Citizen Country of Citizenship other than U.S._____________________________
ACADEMIC INFORMATION
Name of High School _____________________________________ City, State_____________________ Graduation Date (mo./yr.) ______/______
Diploma Type: Standard Advanced Occupational Certificate Did you receive a GED? Yes No
When and where did you complete your GED? (mo./yr.) ________/________ Location_____________________________________
PREVIOUS COLLEGE INFORMATION
Have you attended any other colleges or universities? Yes No If yes, list all colleges or universities you have attended.
Name/Location___________________________________________ Dates______-______Graduated Yes No Degree Type AS BS MS
Name/Location___________________________________________ Dates______-______Graduated Yes No Degree Type AS BS MS
Name/Location___________________________________________ Dates______-______Graduated Yes No Degree Type AS BS MS
Name/Location___________________________________________ Dates______-______Graduated Yes No Degree Type AS BS MS
*If you have more schools, please list at the bottom Has either of your parents or legal guardians graduated from a four year college? Yes No
ENROLLMENT STATUS
First-time Freshman Returning Transfer Transient Accelerated High School Non-degree Seeking Audit (No Credit)
Are you on suspension from another collegiate institution? Yes No Are you applying for financial aid? (scholarship or grant) Yes No
MILITARY AND SELECTIVE SERVICE STATUS
Military Status: Are you a veteran? Yes No Currently on Active Duty? Yes No Eligible to receive VA benefits? Yes No
Selective Service Status:
I certify that I comply with the United States Selective Service Act (50 U.S.C. App 453) by having registered with the Selective Service Boards
No I am not yet 18 years of age, and I will register when I reach 18 years of age.
I am not required by law to register because: I am not a U.S. citizen Other (state reason) _______________________________________
PLEASE READ AND SIGN
I declare that I will use any funds received under Title IV Financial Assistance solely for the educational expenses connected with my attendance at Bishop State Community College. I authorize Bishop State
Community College to deduct from my financial aid proceeds (if any) all outstanding institutional charges, including bookstore. I give my voluntary consent to receive electronic transactions for any and all
financial information provided and for all notices and authorizations to FSA recipients required under 34 CFR 668.165. I certify that the information contained in this application is true and correct. I
understand any misrepresentation of facts may result in the denial of this application or expulsion from Bishop State Community College.
Signature of Applicant _____________________________________________________________________ Date ___________________________
The Alabama Community College Board of Trustees through the Alabama Community College System proclaims nondiscriminatory practices in Alabama two-year institutions under the jurisdiction of the Alabama
Community College Board of Trustees. It is the official policy of the Alabama Community College System and Bishop State that no persons shall, on the basis of race, color, disability, sex, religion, creed, national origin, or
age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or employment. Rev. 10/2018
Processed by: ___________
Date: __________________
Stu # __________________
CERTIFICATION OF ELIGIBILITY FOR IN-STATE RESIDENCY
Main Campus: 351 North Broad St, Mobile, AL 36603 - (251) 405-7005
Carver Campus: 414 Stanton Rd, Mobile, AL 36617 - (251) 662-5362
Central Campus: 1365 Dr. Martin L King Jr. Ave, Mobile, AL 36603 - (251) 405-4400
Southwest Campus: 925 Dauphin Island Pkwy, Mobile, AL 36605 - (251) 665-4085/4114
Student Name (First, Middle, Last)___________________________________________________________________________________________
Street Address____________________________________________________________City______________________State______Zip__________
Home Phone (________) ________________________ Cell (________) __________________________ Date of Birth _______/_______/________
Semester: Fall Spring Summer Year________ Citizenship: U.S. Citizen U.S. Resident/U.S. Permanent Resident/U.S. Alien
In order to be eligible for in-state tuition, you MUST complete this form and fall into ONE or more of the following categories:
I. I AM A LEGAL RESIDENT OF THE STATE OF ALABAMA.
I (or my non-estranged spouse) have lived in the State of Alabama for at least 12 continuous months immediately preceding the first day of
my intended term of enrollment.
I am a dependent student and my parent/legal guardian has lived in the State of Alabama for at least 12 continuous months immediately
preceding the first day of my intended term of enrollment.
I graduated from an Alabama High School or obtained a GED in the State of Alabama within three years of the first day of my intended term
of enrollment.
The address shown on my application is my residence in the State of Alabama and I intend to remain in Alabama indefinitely.
I have more substantial connections with the State of Alabama than with any other state.
CHECK ALL THAT APPLY:
Consideration of the location of high school graduation
Payment of Alabama state income taxes as a resident
Ownership of a residence or other real property in the state and payment of state ad valorem taxes on the residence or property
Full-time employment in the state
Residency in the state of a spouse, parents, or children
Previous periods of residency in the state continuing for one year or more
Voter registration and voting in the state
Possession of state and local licenses to do business or practice a profession in the state
Ownership of personal property in the state and payment of state taxes on the property
Possession of state license plates
Continuous physical presence in the state for a purpose other than attending school, excluding temporary absences for travel, military service,
and temporary employment
Membership in religious, professional, business, civic or social organizations in the state
Maintenance in the state of checking and savings accounts, safe deposit boxes or investment accounts
In-state address shown on one or more of the following:
selective service registration driver’s license hunting/fishing license annuities or retirement plans
automobile title registration insurance policies last will and testament stock/bond registrations
II. I AM A NON-RESIDENT WHO MEETS THESE QUALIFICATIONS FOR IN-STATE TUITION
I (or my supporting spouse or parent) am a member of the U.S. military on full-time active duty and stationed in Alabama under orders for
duties other than attending school.
I (or my supporting spouse or children) am using Post 911 GI Bill or MGIB-AD and am living in the State of Alabama and have enrolled
within three years of my qualifying discharge.
I (or my supporting spouse or parent) am an accredited member of a consular staff assigned to duties in Alabama.
I (or my supporting spouse or parent) have full-time employment in Alabama and will start said employment within 90 days of my registration.
I (or my supporting spouse or parent) am a full-time permanent employee of Bishop State Community College.
I (or my supporting spouse or parent) reside in one of the following Mississippi or Florida counties listed below:
George Co., MS Greene Co., MS Harrison Co., MS Jackson Co., MS Perry Co., MS Stone Co., MS
Escambia Co., FL Santa Rosa Co., FL
I understand that I may be asked to provide documentation for items that I have checked. I agree to notify the college if there are any changes
in the information submitted with this form. I understand that an out-of-state student cannot attain residency simply by attending school for
12 continuous months in the State of Alabama.
Signature of Applicant ______________________________________________________________________________ Date __________________
The Alabama Community College Board of Trustees through the Alabama Community College System proclaims nondiscriminatory practices in Alabama two-year institutions under the
jurisdiction of the Alabama Community College Board of Trustees. It is the official policy of the Alabama Community College System and Bishop State that no persons shall, on the basis of
race, color, disability, sex, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or
employment.
ACCELERATED HIGH SCHOOL STUDENT
PROGRAM CERTIFICATION
OFFICE OF ADMISSIONS AND RECORDS ∙ 351 N. BROAD ST. ∙ MOBILE, AL 36603 ∙ 251-405-7005
Student’s Name_______________________________ SS# or Bishop ID#___________________
High School/Home School Cover School_____________________________________________
This is to certify that the above name student has completed the 10
th
grade, has a minimum
unweighted GPA of 3.0, and is recommended for participation in the Accelerated High School
Program at Bishop State Community College.
______________________________________
Signature of Principle or Designee
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APPLICATION FOR ADMISSION (Bishop State Community College)

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Completed 25 July 2020

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