Howard Community College

14 | Howard Community College SUMMER Schedule of Classes 2018 Register Online: howardcc.edu U.S. CITIZENSHIP Are you a US citizen?* Yes No – If you are NOT a U.S. citizen, please indicate: Country of Nationality___________________________________ Immigration/Visa Status** __________________________________ **Original documents verifying status are required at the time of application. RACIAL/ETHNIC INFORMATION Colleges and universities are asked by many, including federal and state governments and national surveys to describe the racial/ethnic backgrounds of students and employees. You should answer both questions. Definitions of these terms are available online: www.howardcc.edu/Visitors/ Webmaster/race_ethnicity.html. Are you of Hispanic or Latino origin? Yes No What is your race? Select one or more of the following categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White ADDITIONAL INFORMATION The following items are optional. Information you provide will not be used in a discriminatory manner. Alternate First Name l l l l l l l l l l l l Alternate Last Name l l l l l l l l l l l l l l Household Income $0-$19,999 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$119,999 $120,000-$139,999 $140,000-$159,999 $160,000-$199,999 Over $200,000 EMERGENCY CONTACT First Name l l l l l l l l l l l l l l l l Middle Name l l l l l l l l l l l l l l l Last Name l l l l l l l l l l l l l l l l l Phone Number l l l l l l l l l l l l l HIGH SCHOOL EDUCATION* Atholton Centennial Glenelg Hammond Howard Long Reach Marriotts Ridge Mt. Hebron Oakland Mills Reservoir River Hill Wilde Lake Home Schooled Unlisted School Name and Address If your high school is not listed above, please enter the school name below. Otherwise, leave this area blank. Name of High School __________________________________________________________________________________________ Unweighted high school GPA Less than 1.0 1.01-2.00 2.01-3.00 3.01-4.00 Prior to registration, which will you have?* High School Diploma Out-of-State GED Will still be in high school and do not have diploma/GED Maryland GED National External HS Diploma No longer in high school and do not have diploma/GED Do not have a high school diploma and have a certificate of completion High School Graduation Date/Year* ________________________________ COLLEGES ATTENDED Name City & State or Country Years Attended Degree _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ STUDENT CONDUCT Are you currently, or have you ever been involved in a disciplinary process which has led to suspension, expulsion or was related to sexual misconduct?* Yes No NOTE: This question does not apply to academic dismissal because of grade point average* Howard Community College's annual security report containing policy statements and crime statistics can be found at howardcc.edu/ annualcrimereport. Paper copies of the report are available upon request at the Office of Public Safety or by calling 443-518-5500. Convicted sex offenders are required to register at the college's Public Safety office prior to registering for any course or program at HCC. Failure to register with the college's Public Safety office will result in disciplinary action including explusion, as outlined in the Student Code of Conduct. All students are required to abide by college policy as outlined in HCC's catalog and Student Handbook, including the Student Code of Conduct. CERTIFICATION Please affirm the following before you submit your application. I certify all information has been accurately presented.* I understand that once my application has been submitted it may NOT be altered in any way. Yes No I certify all information has been honestly presented.* Yes No I certify all information has been completely presented.* Yes No Signature*______________________________________________________________ Date*______________________________ Military Status: If you have been (or are a dependent of someone) in the military, please indicate which branch: Air Force Coast Guard Army Marine Corps Navy Please select your military affilliation: (leave blank if none apply) Active Duty Maryland National Guard Reserves National Guard Dependent of Active Duty Are you a veteran or a dependent of a veteran? (leave blank if neither apply) Veteran Dependent of a Veteran

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