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)

*Gender

*Application Type
  Application Type Definitions

Is English your primary language?

Are you Hispanic or Latino?

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

*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 Mother/guardian

*Highest level of education completed by your Father/guardian

Permanent Address (P.O. Boxes not valid)

*Address 1

Address 2
 

*City

*State

*Zip

*County of Residence

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

*Primary Phone
( ) - -

*E-mail address

*Confirm E-mail address

Mailing Address

Same as Permanent Address

*Address 1
Address 2
 

City

State

Zip
 

Academic Information
High School Information


College Information
Colleges Attended



Signature

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

spacer Date