UNIVERSITY OF ARKANSAS - ONLINE

UNIVERSITY OF ARKANSAS
COMMUNITY COLLEGE
AT HOPE

PHILLIPS COMMUNITY
COLLEGE OF THE
UNIVERSITY OF ARKANSAS

UNIVERSITY OF ARKANSAS
COMMUNITY COLLEGE
AT BATESVILLE


APPLICATION FOR ADMISSION



BIOGRAPHICAL INFORMATION

State: 

First Name:

Zip:
Middle Name: Home Phone:
Last Name: Work Phone:

Address:

Fax:

City:

Email:
When did you begin living in Arkansas?  Month:    Year:   County:

ENROLLMENT INFORMATION - The Associate of Arts Degree

Enrolling for (select one):   Year:

Enrollment Status (select one):

For which of the following reasons are you interested in seeking higher education:


EMERGENCY CONTACT INFORMATION

Name:   Relationship:

Telephone:   Address: 

EDUCATIONAL INFORMATION

High School you attended/attend:   Date of Graduation:

If you have not graduated, do you hold a GED 

Date Received:    State that issued GED:

List all colleges or universities at which you have taken courses for credit.  In order to receive credit, you must provide a transcript to the Student Affairs office.

Name of College, Location (City, State), Degree and/or Credit Hours, Dates Attended:

 

The following information will be used for reporting purposes only.

Sex:   Birth Date:   Place of Birth:

Ethnic Origin:

Have either of your parents graduated from college?


The University of Arkansas Community Colleges, in accordance with Arkansas law, require entering students to provide proof of immunization of both measles and rubella or proof of exemption from this requirement.

Selective Service Declaration

All people seeking admission to The University of Arkansas Community Colleges must complete this form in accordance with ACT 228 of 1997.

Sworn under penalty of perjury, I certify that I am:

Registered with the selective service of the United States of America:

Not registered with the selective service because I am:


CERTIFICATION

I hereby certify that all information is complete and accurate.  By submitting this form, I understand that I will not be considered for admission to the University of Arkansas Community Colleges until I have submitted all documentation specified for admission and enrollment.  Upon registration, student agrees that voice, physical presence, and participation in virtual classroom activities may be transmitted to distance sites and electronically recorded.