Application for GRCC Admission

Application for GRCC Admission

Required fields (*)
Personal Information

*First Name (Legal)

Middle Name

*Last Name

Social Security Number
(required for financial aid)

*Birth Date
/ / (mm/dd/yyyy)


*Application Type

Is English your primary language?

Are you Hispanic or Latino?

What is your race? Select one or more.
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander

*Have you applied to or attended GRCC under a different name?

Have you ever served or are currently serving in the United States Armed Forces?

Are you the spouse or dependent of an individual who has served or is currently serving in the United States Armed Forces?

*How did you hear about GRCC?

*Highest level of education completed by your first parent/guardian

*Highest level of education completed by your second parent/guardian

Permanent Address (P.O. Boxes not valid)

*Address 1

Address 2




*County of Residence

*Lived at my permanent address (above) since
/ (mm/yyyy)
*School District in which you currently live

Mobile Phone
( ) - -

Other Phone
( ) - -

*E-mail address

*Confirm E-mail address

Mailing Address

Same as Permanent Address

*Address 1
Address 2




Academic Information
High School Information

College Information
Colleges Attended


I certify that the information on this application form is true and correct, and I realize that giving misinformation may lead to disciplinary action.

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