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Application for Admission
CURRENT NAME (Required fields are in red)
Last Name:     Full First Name:    Middle Initial:
FORMER NAME(s)
Last Name: Full First Name: Middle Initial:
Address: City: State: Zip:
County:    Phone:
 Email Address:     *Social Security Number:  
*GENDER: Male   Female       *Date of Birth:
*ETHNIC BACKGROUND:
White (01) Asian (03) Hispanic (05)
Black (02) American Indian (04) Other (07)
*CITIZENSHIP STATUS:
U.S. Citizen
Non-resident Alien (06) - Country of Citizenship:
Permanent Resident - Alien Registration #:
*Indicates optional information, failure to provide this information will NOT affect your acceptance at Glen Oaks.
Educational Background
Last high school attended:
Address: City: State: Zip:
Date of high school graduation: (month/year)
GED (month/year)       Non-graduate
                                                              *Highest grade completed.
College(s) attended (List most recent first):
Name of College(s):  
College - City / State:
Name of College(s):  
College - City / State:
Name of College(s):  
College - City / State:
*Do either of your parents have a four-year college degree (bachelors)?
         Yes    No
*Indicates optional information, failure to provide this information will NOT affect your acceptance at Glen Oaks.
Educational Intent
I plan to start classes in 20
FALL (Aug./Sept.) WINTER (Jan.) SPRING/SUMMER (May/June)
I plan to attend as a (check one)
    New (First-time in any college)
    Returning (Prior GOCC student) year last attended
    Transfer (Previous enrollment at another college
    College Guest (Attending GOCC temporarily)
    High School Guest (Attending while still in H.S.)
       (NOTE: Must submit Early College Admissions Application)
I plan to (check one)
    Earn a Certificate or Associate Degree
    Transfer to a four-year college or university
    Gain the skills necessary to enter a new occupation, or retrain or advance
          in my present position
    Satisfy a personal interest
    My educational plans are uncertain at this time
    Apprenticeship
Please check a box for the anticipated program of study:
Accounting (103)
Admin. Office Assist.-Medical (160)
Automotive Service (106)
Automotive Technician (109)
Child Care (116)
Computer Information Sys. (155)
Database/Programming (156)
Drafting & Design (127)
Early Childhood Education (128)
Electronic Technology (130)
*Emerg. Med. Tech.-Basic (170)
*Health Ins. Coder/Biller-Technical (172)		 *Health Ins. Coder/Biller Hosp./Spec. (174)
Machine Tool Tech. Level I (137)
Management/Marketing (145)
*Medical Assistant (169)
Medical Transcription (165)
Office Administrative Asst., Executive (161)
Office Administrative Asst., Legal (162)
Practical Nursing, LPN (004)
NOTE: If selecting an Occupational Degree you must also select a Certificate program.
*Must apply to the Assistant Dean of Nursing & Allied Health for selective admissions.
Please check a box for Transfer Degree Programs:
Associate of Arts (201)
Associate of Business (220)
Associate of General Studies (206)		 Associate of Science (210)
Assoc. of Early Childhood Education (203)
Please check a box for Occupational Degree Programs:
Assoc. of Applied Science in Allied Health
Assoc. of Applied Science in Business
*Assoc. of Applied Science in Nursing
 Associate of Science in Technology
NOTE: If selecting an Occupational Degree you must also select a Certificate program.
*Must apply to the Assistant Dean of Nursing & Allied Health for selective admissions.
Please check a box for Other Programs:
Undecided, Seeking Degree/Cert.
Transfer; Not completing a degree/cert.		 Personal Interest
       (Lifelong Learning/Job Skills)
Joint Transfer Program w/Another College
     Refer to GOCC Catalog to indicate
       program name.
If program of interest is not listed, please enter the program name here:
Interests and Activities
Art Athletics (name of sport): Choir
**I plan to Dual Enroll (month/year) Current grade in high school
**To be completed by public high school students who wish to participate in the Postsecondary Enrollment Option program.
If you have questions, call the GOCC Admissions Office,
toll free 1-888-994-7818 or 467-9945.
The Board of Trustees of Glen Oaks Community College affirms that through its admission, recruitment, employment and educational policies, practices and programs, the College will seek to provide equal opportunity and affirmative action for everyone. The College shall not discriminate against anyone because of color, race, sex, sexual orientation, national origin, religion, age, creed, height, weight, marital status, or disability. For inquiries, contact the Title IX/504 coordinator who is located in the counseling office.
Submission of this form by "s/Name" electronically, shall constitute my signature on the form. By submitting this form, I certify that all answers on this application are complete and accurate to the best of my knowledge. I understand that incorrect or incomplete information submitted by me may result in delay, denial or withdrawal of admission, financial assistance or continued attendance.