Admissions Application - Northwest Mississippi Community College
Admissions Application - Northwest Mississippi Community College
Admissions Application - Northwest Mississippi Community College
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Application</strong> for admission<br />
Registrar’s office<br />
4975 Hwy 51 north<br />
P.O. Box 7047<br />
Senatobia, ms 38668<br />
Social Security Number: _______ - _____ - _________<br />
Phone Number: ( ) - _________ - _____________<br />
E-mail: _____________________________________________________@________________________________________<br />
*Non-degree seeking students are not eligible for financial aid.<br />
Intended Major: __________________________ Major Code: _____________ Degree Seeking / Non-degree Seeking*<br />
(See reverse for codes)<br />
(mark one)<br />
Campus you plan to attend:<br />
Personal information Senatobia DeSoto Oxford Online Ashland<br />
Name:________________________________________________________________________________________________<br />
Last First Middle Maiden<br />
Physical Address:______________________________________________________________________________________<br />
Street City State Zip County<br />
Mailing Address: ______________________________________________________________________________________<br />
if different from physical Street or P.O. Box City State Zip County<br />
Date of Birth: ___/___/____ City/State/Country of Birth: _______________________ MS Resident?<br />
Gender:<br />
Race/Ethnicity: Are you Hispanic/Latino?<br />
Yes No<br />
Male Female<br />
Yes No<br />
U.S.Citizen?<br />
What is your race? (You may choose more than one) ___White ___ Black or African American<br />
Yes No ___ Asian ___ American Indian or Alaska Native ___ Native Hawaiian or Other Pacific Islander<br />
Family Information<br />
**If you choose guardian, you must mail in official guardianship documents.<br />
Choose One: ___ Parent ___ Guardian** ___Spouse Name: ______________________________________________<br />
Last<br />
First<br />
Mailing Address: ___________________________________________________________________________________<br />
Street or P.O. Box City State Zip<br />
High School information If any of your transcripts are from out of state, you must provide proof of residency.<br />
Official high school transcript or GED and ACT scores (see NWCC catalog for exceptions) are required for admission to be complete.<br />
High School: _________________________________________________________ Graduation Date: ___________________<br />
Location: ___________________________________<br />
(Month/year)<br />
GED Information<br />
City<br />
State<br />
Do you have a GED diploma?<br />
If yes, graduation date: _________ State where GED was completed: _______<br />
Yes No<br />
(Month/Year)<br />
<strong>College</strong> Information<br />
All official college transcripts are required for admission to be complete.<br />
Have you ever attended NWCC?<br />
Name at time attended: __________________________________________<br />
Last<br />
First<br />
Yes No<br />
Dates attended: _____________________<br />
List all colleges previously attended:<br />
Failure to list complete and accurate information could result in the cancellation of your enrollment.<br />
__________________________________________________________________________________________<br />
__________________________________________________________________________________________<br />
__________________________________________________________________________________________<br />
What semester do you plan to attend NWCC? ___ Fall ___Spring ___ Summer What year? _____________________<br />
Applicant’s signature: ________________________________________________________________________________ date: _______________________<br />
I certify the information I have provided on this application is accurate and that I have not intentionally withheld information requested.<br />
I further understand that falsification of information is a basis for denying admission or for immediate termination of enrollment. My<br />
signature above also authorizes the release of my transcripts from all schools previously attended to <strong>Northwest</strong>’s Registrar’s office.<br />
X
ASSOCIATE OF ARTS DEGREE<br />
205 Accountancy<br />
120 Animal Science<br />
405 Art<br />
704 Biology<br />
220 Business & Computer Teacher<br />
Education<br />
218 Business Administration<br />
708 Chemistry<br />
416 Communications/Public<br />
Relations<br />
410 Communications/Broadcasting<br />
415 Communications/Journalism<br />
213 Computer/Management<br />
Information Systems<br />
712 Computer Science<br />
515 Criminal Justice<br />
305 Elementary Education<br />
345 Exercise Science<br />
130 Forestry<br />
510 General <strong>College</strong> Curriculum<br />
105 General Agriculture<br />
ASSOCIATE OF APPLIED SCIENCE<br />
6005 Accounting Technology<br />
6022 Agricultural Business & Mgmt<br />
Tech/Animal Husbandry<br />
6010 Agricultural Tech/John Deere<br />
Tech<br />
8014 Automotive Technology<br />
8014 Automotive Tech/Chrysler<br />
<strong>College</strong> Auto Program<br />
6012 Aviation Maintenance Tech<br />
6045 Business & Marketing<br />
Management Tech<br />
6098 Cardiovascular Technology<br />
6030 Civil Engineering Technology<br />
6032 Civil Engineering Tech/Pre-<br />
Surveying/Geomatics MSU<br />
CODES FOR MAJORS<br />
724 General Science<br />
340 Health & Physical Education<br />
505 Liberal Arts<br />
417 Marketing Communications/PR<br />
Mgmt<br />
784 Mathematics<br />
420 Music, Music Education, Music<br />
Performance<br />
423 Music Business/Industry<br />
605 Nursing (Associate Degree)<br />
240 Office Administration<br />
131 Outdoor Recreation & Mgmt<br />
788 Physics<br />
720 Pre-Architecture<br />
744 Pre-Clinical Laboratory Sciences<br />
347 Pre-Communicative Disorders<br />
730 Pre-Cytotechnology<br />
732 Pre-Dental<br />
734 Pre-Dental Hygiene<br />
716 Pre-Engineering<br />
710 Pre-Forensic Chemistry<br />
6052 Drafting & Design Engineering<br />
Tech/Arch Eng<br />
6050 Drafting & Design Engineering<br />
Tech/ Gen Drafting<br />
6025 Early Childhood Education<br />
Technology<br />
6070 EMT-Paramedic<br />
6085 Funeral Service Technology<br />
6035 Graphic Design Technology<br />
6079 Health-Care Data Technology<br />
8015 Heating, Air Conditioning &<br />
Refrigeration Tech<br />
6065 Hotel & Restaurant Mgmt Tech<br />
6056 Industrial Electronics<br />
Engineering Tech<br />
127 Pre-Health Information<br />
Management<br />
742 Pre-Health Sciences<br />
726 Pre-Horticulture<br />
718 Pre-Landscape Architecture<br />
722 Pre-Landscape Contracting<br />
736 Pre-Medical<br />
748 Pre-Nursing (BSN)<br />
752 Pre-Occupational Therapy<br />
738 Pre-Optometry<br />
756 Pre-Pharmacy<br />
760 Pre-Physical Therapy<br />
764 Pre-Radiological Sciences<br />
768 Pre-Veterinary Medicine<br />
770 Pre-Veterinary Medical Technology<br />
520 Psychology<br />
342 Recreation<br />
307 Secondary Education<br />
535 Social Work<br />
425 Theatre<br />
6038 Information Systems Tech/<br />
Computer Networking<br />
6041 Information Systems Tech/<br />
Computer Programming<br />
6009 Microcomputer Technology<br />
6014 Office Systems Technology<br />
6090 Paralegal Technology<br />
6099 Paralegal Tech/Pre-Paralegal<br />
Studies UM 2+2 Option<br />
6093 Respiratory Therapy<br />
6092 Surgical Technology<br />
7005 Precision Manufacturing and<br />
Machining Technology<br />
CAREER CERTIFICATE<br />
6031 Civil Engineering Technology<br />
(One-Yr Certificate)<br />
8005 Collision Repair Technology<br />
8075 Commercial Truck Driving<br />
8035 Cosmetology<br />
8036 Cosmetology/Nail Technician<br />
Option<br />
6071 EMT-Basic<br />
8062 Health Care Assistant<br />
6013 Office Systems Technology (One-<br />
Yr Certificate)<br />
8060 Practical Nursing<br />
8070 Welding And Cutting<br />
AFFIRMATIVE ACTION—<strong>Northwest</strong> <strong>Mississippi</strong> <strong>Community</strong> <strong>College</strong> does not discriminate on the basis of race, color, national origin, sex, religion, age, disability<br />
or status as a veteran or disabled veteran in employment, programs, or provision of services. Compliance with Section 504 of the Rehabilitation<br />
Act of 1973 and the Americans with Disabilities Act is coordinated by Mr. Michael Dottorey, Disability Support Services Coordinator, McLendon Student<br />
Center, P.O. Box 5555, Highway 51 North, Senatobia, <strong>Mississippi</strong> 38668, telephone number 662-562-3309, email address mldottorey@northwestms.<br />
edu. Compliance with Title II of the Age Discrimination Act and Title IX of the Education Amendments of 1972 is coordinated by Mr. Gary Mosley, Vice<br />
President for Fiscal Affairs, James P. McCormick Administration Building, P.O. Box 7017, 4975 Highway 51 North, Senatobia, <strong>Mississippi</strong>, 38668, telephone<br />
number 662-562-3216, email address gtmosley@northwestms.edu.