Note: As of May 11, 2007, fees are waived for online applications ONLY. Applications submitted on paper will incur a $30 one-time processing fee.
2. Any other legal name ( former ) (Last, First, Middle)
3.Permanent Address (Number & Street, Apt.) ( City, State, Zip Code)
4.Home Telephone:
5.Email Address:
6. Gender: Female Male
7. Date of Birth
8. Statement of Residency NOTE: If you are visiting or living with a relative who is not your parent or guardian, you are NOT considered a legal resident of Bucks County.
Are you a citizen of the United States?
Are you a legal resident of Pennsylvania?
Are you a legal resident of Bucks County?
If not a resident of Bucks County, in what county do you reside?
9. Ethnic Background
(This information is voluntary and is used only for reporting purposes. It will not be used for an admissions decision)
10. The College provides academic adjustments in accordance with Sec. 504 and the Americans with Disabilities Act. Students should provide reason able notice of need for adjustments prior to enrollment by contacting the Office of Disability Services, (215) 968-8463 (V), (215) 504-8561 (TDD).
11. Parent, Guardian or Spouse
12. Employer
13. When do you wish to enter Bucks County Community College?
Please check appropriate boxes
Summer Session: If you plan to attend the Fall Semester check here
14. Post Secondary Education Information:
Previous or present colleges attended (list most recent first)
Institution name
15. This application is for enrollment status of: (check one)
16. Current Educational Goals Check one:
If applicable, college to which you plan to transfer:
Note: Financial Aid is available only to students seeking a degree or certificate. For eligibilty, students must be working toward a degree or certificate at Bucks or planning to transfer to a four-year institution to earn a degree.
17. Major to which you seek Admissions
Do you have a definite career or occupation in mind for which you are now preparing?
If yes, please write your career choice:
18. Educational Information:
High School or Preparatory School from which you graduated or expect to graduate.
Date of high school graduation or anticipated date:
Check here if you have a GED Date GED issued Print name as it will appear on this transcript
19. What Influenced You to Apply to BCCC? Check one:
Financial Aid to attend Bucks County Community College is available; all new applicants will automatically receive Financial Aid information.
I certify that the information on this application is complete and accurate in every respect. I realize that failure to provide accurate and/or complete information can result in cancellation of this application, and/or revocation of admissions.
Signature of Applicant
______________________________________
Date_________________________
A $30 non-refundable application fee must accompany this application for admission if this is the first time that you have applied to Bucks County Community College.
Occupational Program Support Services are available through the Carl D. Perkins Grant to students seeking Occupational Degrees and Certificates. Eligible students must be single parents, displaced homemakers, academically or financially disadvantaged, or speak English as a second language. Please contact the OPSS Office at 215-968-8140 for details of services available.
Name Semester you wish to attend: Fall Spring Summer Year
Received by _________________ Date _______________
Student No._____________________________________
Receipt # ____________________________________