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If you have questions, call GOCC Admissions
toll free 1-888-994-7818 or 269-467-9945.



Please note: Dual Enrollment and High School Guest students must complete the Early College Guest Application

(Required fields are in red)

Current Name
Last Name:
Full First Name:
Middle Initial:
Suffix (optional):
Former Name(s)
Last Name:
Full First Name:
Middle Initial:
Suffix:

Contact Information
Street Address:
City:
State:
Zip:
County:
Phone:
Email Address:

Additional Information
Social Security Number:
Gender: Male
Female
Date of Birth:
Alternate Phone:


We request your Social Security Number and Date of Birth for identification purposes only. You must provide a Social Security Number to apply for Financial Aid. Failure to do so may result in IRS penalties.
* Race and Ethnicity
This section is voluntary.  Demographic information is reported to the U.S. Office for Civil Rights under Title VI of the Civil Rights Act of 1964 and Title IX of the Education Ammendments of 1972. It is not used in admissions decisions, and will not be used in a discriminatory way for participation in, access to, or benefits of programs or services of the college.

Select all that apply:

White (01)
Asian (03)
Other/Unknown (07)
Black or African American (02)
American Indian or Alaska Native (04)
Native Hawaiian or other Pacific Islander (08)


Are you Hispanic/Latino(05) Yes
No




* Citizenship Status
U.S. Citizen

Non-US Citizen (06) - Country of Citizenship:

Permanent Resident - Alien Registration #: Country of origin:

* Indicates optional information. Failure to provide this information will NOT affect your acceptance at Glen Oaks.



Military Status
Active Military Active Reserve Military Previously Served in Military
 
No Military Service




Please select and complete either High School or GED information


High School
Last high school attended:
City:
State:
Zip:
Please select one of the following:
I received or will receive a high school diploma. Date Awarded:
I recieved a High School Completion Certificate. Date Awarded:
I did not graduate. Highest grade completed:

GED
Testing Site:
(month/year):


College History

List most recent first; first time college students should leave this blank.


College 1
Name of College(s):
College - City / State:

College 2
Name of College(s):
College - City / State:

College 3
Name of College(s):
College - City / State:


Parent's Educational Attainment
* 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.






Starting Semester
I plan to start classes in 20

FALL (Aug./Sept.) WINTER (Jan.) SPRING/SUMMER (May/June)


Student Status
First-time in any college
(Post High School Graduation)

  Former GOCC student:
Year last attended
(Excluding high school dual enrollment)

Transfer
(Previous enrollment at another college)

Guest student from another college

International Student

Taking classes while in high school
(NOTE: Must submit Early College
Admissions Application)
Plans
 Earn an Occupational Certificate or Associate Degree

 Transfer to a 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


Please choose a Certificate option

None
None (if Transfer Degree or Other Program)

Certificates

Accounting (103)
Automotive Service (106)
Automotive Technician (109)
Coding Specialist- Physician Based (182)
Computer Information Sys. (155)
Computer Support Technician (159)
Database/Programming (156)
Early Childhood Education (128)
Educational Paraprofessional (125)
Electrical Technologies (129)
* Health Care Worker (184)
Management/Marketing (145)
Management/Supervision (149)
Medical Administrative Specialist (181)
* Medical Assistant (169)
Mobile Phone Application Development (177)
* Phlebotomy Technician(183)
** Practical Nursing, LPN (004)
Web Design (157)

* Must apply to the Allied Health Department for selective admissions.
** Must apply to the Director of Nursing for selective admissions.



Please select a Degree Program:

None
None (if solely completing a certification)


Occupational Degrees
* Associate of Applied Science in Allied Health (270)
Associate of Applied Science in Business (250)
** Associate of Applied Science in Nursing (005)
Associate of Science in Technology (230)

NOTE: If selecting an Occupational Degree you must also select a Certificate program.

* Must apply to the Allied Health Department for selective admissions.
** Must apply to the Director of Nursing for selective admissions.


Transfer Degrees
Associate of Arts (201)
Associate of Applied Science in Criminal Justice (280)
Associate of Business (220)
Associate of Education and Human Services with Emphasis in Early Childhood Education (223)
Associate of Education and Human Services with Emphasis in Elementary Education (224)
Associate of Education and Human Services with Emphasis in Family LIfe Education (225)
Associate of Education and Human Services with Emphasis in Secondary Education (226)
Associate of Education and Human Services with Emphasis in Special Education (227)
Associate of General Studies (206)
Associate of Science (210)
Associate of Arts in Visual Arts with emphasis in Commercial Photography (216)
Associate of Arts in Visual Arts with emphasis in Fine Arts (217)
Associate of Arts in Visual Arts with emphasis in Graphic Design (218)



Other Programs
Undecided, Seeking Degree/Cert.(002)
Transfer; Not completing a degree/cert. (006)
Personal Interest (001") (Lifelong Learning/Job Skills)
Joint Transfer Program w/Another College (011)
Refer to GOCC Catalog to indicate program name.


Not listed, enter here:



Glen Oaks Community College is committed to a policy of providing equal access to education for all persons regardless of race, color, sex, age, religion, national origin, sexual orientation ,disability, veteran status, or other status as protected by law.  The College's nondiscrimination policy applies to admissions, employment, and access to college programs and activities.  This policy applies to all persons employed at GOCC, enrolled as a student, seeking admission to the college, requesting employment at, or having contracts with the college.  The College values diversity and seeks talented students, faculty and staff from diverse backgrounds.  The College does not discriminate in the administration of educational policies, programs or activities: admission policies: scholarship and loan awards: or other college administered programs or employment.  The College's Civil Rights Coordinator has copies of all Acts and regulations and can provide information on grievance procedure and will investigate all complaints.  Inquiries concerning the non-discriminatory policy may be directed to Director, Office of Civil Rights, U.S. Dept. of Education, 400 Maryland Ave. S.W., Washington, D.C. 20202  Phone (216) 522-4970


Submission of this form electronically, shall constitute my signature on the form. By submitting this form, I certify that the information given on this application is correct and complete to the best of my knowledge, and I agree to observe all the rules and regulations of Glen Oaks Community College.  I understand that false information on this application may result in my dismissal from Glen Oaks Community College.

By signing this application, I am also granting permission for the institution to use my image for marketing, communication, and advertising/promotional purposes. If I do not want my image used in these materials, I must state my objection to the photographer/videographer during the shoot and/or in writing, or submit my request to the Director of Communications and Marketing.