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GUEST STUDENT REGISTRATION FORM

Enroll

Do not use this form to make name, address, or program changes. Contact the Office of Records and Registration at admissions@camdencc.edu to make changes to an application that has already been submitted.

Term for which you desire admission

Applicant Type
(students who have not attended in five years or who have graduated from Camden County College)

Have you ever attended any other college or university?

1. Title

2. Legal Name
Last
First
Middle
Maiden
Suffix

3. Other Name: (If applicable)
Last
First
Middle

4. E-mail Address

5. Home Address (Address where you reside in the US; do not use a P.O. Box)
Street
Apt No.
City
State
Zip

6. Mailing Address (If different from Home Address)
Street
Apt No.
City
State
Zip

7. County of Legal Residence

8. State of Legal Residence

9. Preferred Telephone Number ) -
Phone Type

10. Social Security Number* Required except for international students

*We are requesting your Social Security Number (SSN) for our system of student records as well as for compliance with federal and state reporting requirements. An SSN is not required to apply for admission, but not providing your SSN when applying for admission could result in a delay in matching materials submitted. The College will not disclose your SSN to anyone outside the institution except as required by law, and will make every effort to protect your privacy. Your social security number will be required at the time of registration.


Please Note: Information containing ethnic background, gender, and age is required for federal reporting. It does not affect admission to Camden County College. Students who are under 18 years of age and will not have earned their high school diploma or GED prior to the start of their first semester must contact the Office of School and Community Academic Programs at (856) 227-7200, ext. 4530..

11a. Ethnicity (Check one)


11b. Race (Check all that apply)






12. Gender

13. Date of Birth (mm/dd/yyyy)

Policy on Non-Discrimination in Educational Programs
Camden County College complies with title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Older Americans Act of 1975 and New Jersey's Law Against discrimination. These laws prohibit discrimination on the basis of race, creed, color, national origin, nationality, ancestry, age, marital status, affectional or sexual orientation, sex, familial status, domestic partnership status, disability and handicap. Decisions on admission, recruitment, financial aid programs, access to course offerings, or other aspects of its educational programs or activities, including vocational programs and vocational opportunities, are not made on the basis of any of these factors. Inquiries regarding these laws may be directed to the Executive Director, Institutional Compliance, Wilson Hall West, Room 103, Camden County College, P.O. Box 200, Blackwood, NJ 08012, (856) 227-7200, extension 4245 or to the Secretary, Department of Education, Washington, D.C. 20201.


Please Note: If you have applied for or intend to apply for financial aid, NJSTARS, veteran's benefits, the Program for the Deaf and Hard of Hearing, vocational education assistance, or a National Guard tuition waiver, you must choose an associate degree program or certificate program.

Selective programs and certain courses require applicants to provide the following
additional information:
  • Your high school transcript
  • Your GED test scores
  • An OFFICIAL transcript from each college listed in question 21.




15.Choose the degree or certificate program that you intend to pursue at Camden County College by clicking the Search link*

Program:
Code:

 
16. What influenced you to apply to Camden County College? (Please select one)

17. Are you a U.S. citizen?


  1. b. If not a U.S. Citizen, are you a permanent resident of the United States?
  1. d. Do you require an I-20 from Camden County College

18. Is English your native language?
If No, what is the language spoken at home?

Previous Education

19. Please enter the last USA high school attended.
  
Name of High School City State Start date
(mm/yyyy)
End date
(mm/yyyy)

If you attended high school outside the USA, enter the last high school attended below.
Name of High School City
Country
Start date
(mm/yyyy)
End date
(mm/yyyy)
 


20. Did or will you graduate from high school?     Month Year of Graduation   
Did you earn a GED?     Month Year Issued            


21. Please enter all colleges attended. (DO NOT INCLUDE CCC OR ENTER A FUTURE GRADUATION DATE)
Name of College City State / Country Start date
(mm/yyyy)
End date
(mm/yyyy)
Degree
Awarded
Month/Year Graduated
(mm/yyyy)



22. Please enter the course information below (The first line is an example)
Session No. Subject/Course No. Title Credits Days Times

PREREQUISITE DECLARATION


I am aware the courses listed above for which I am registering may have one or more prerequisites.
I hereby certify the following:





Certification


I certify that the above answers are true, correct and complete to the best of my knowledge. If any statement is not true, I understand I will be held responsible. Further, I agree to abide by the rules and regulations of Camden County College as outlined in the College Catalog and the Student Handbook and other College publications.

     (mm/dd/yyyy)

Information on financial assistance, FERPA, graduation, completion, and transfer-out rates, as well as information on campus safety and security, including crime statistics, can be found on the Consumer Information link on the bottom of the College's home page at www.camdencc.edu.

Affirmative Action/Equal Opportunity Employer