DACC Catalog - Dona Ana Community College - New Mexico State ...

CitizenshipPermanent Residents must submit acopy of their I-551 card. Passport andvisa will be requested as needed.Students who request an I-20 will berequired to meet the InternationalApplicant requirements. Students whofalsify their citizenship may have theiradmission revoked.Ethnicity/Race (Optional)This information is requested bygovernment agencies to demonstratecompliance with the Civil Rights Act.ResidencyResidents of New Mexico for morethan one year and residents of someother states may qualify for in-statetuition.For more information, visithttp://www.nmsu.edu/~registra/residency.html US Citizen Permanent Resident Foreign Other Immigrant Status __________________________________________________If other immigrant status, what is your country of citizenship? ________________________________________________What is your ethnicity? Hispanic or Latino Not Hispanic or LatinoSelect one or more races to indicate what you consider yourself to be. American Indian or Alaskan Native Principle tribe or pueblo ___________________________________ Asian Black or African American Native Hawaiian or Other Pacific Islander WhiteIf you are less than 23 years old, were you reported as a dependent on your parent or legal guardian’s federalincome tax return for last year? Yes No If yes, in what state were taxes filed? ______________________What is your state of legal residence? _____________________________________If a New Mexico resident, as of the date of this application how long have you been living continuously in NM?Years __________ Months __________ Days __________If New Mexico is your state of legal residence, what county do you live in? ____________________________________SECONDARY CONTACT INFORMATION: CONTACT 1NameLAST NAME FIRST NAME MIDDLE NAMEAddress Mother Father Spouse Emergency contact Check if this person is a graduate of NMSU.STREET AND NO. OR PO BOX NO.APARTMENT, ROOM OR SPACE NO.CITY STATE ZIP CODEPhone - - - - HOME PHONECELL PHONEEmailEMAILSECONDARY CONTACT INFORMATION: CONTACT 2NameAddressLAST NAME FIRST NAME MIDDLE NAME Mother Father Spouse Emergency contact Check if this person is a graduate of NMSU.STREET AND NO. OR PO BOX NO.APARTMENT, ROOM OR SPACE NO.CITY STATE ZIP CODEPhone - - - - HOME PHONECELL PHONEEmailEMAIL2 20111103