Application For Admission


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APPLICATION FOR ADMISSION

DOWNRIVER CAMPUS
21000 Northline Rd. Taylor, MI 48180 734-946-3500

DOWNTOWN CAMPUS
1001 W. Fort St. Detroit, MI 48226
313-496-2758

EASTERN CAMPUS
5901 Conner St. Detroit, MI 48213
313-922-3311

NORTHWEST CAMPUS
8200 W. Outer Drive Detroit, MI 48219
313-943-4000

TED SCOTT CAMPUS
9555 Haggerty Rd. Belleville, MI 48111
734-699-7008

MARY ELLEN STEMPFLE UNIVERSITY CENTER
19305 Vernier Rd. Harper Woods, MI 48225
313-962-7150

www.wcccd.edu • 313-496-2600

MISSION STATEMENT
Wayne County Community College District’s mission is to empower individuals, businesses, and communities to achieve their higher education and career advancement goals through excellent, accessible, culturally diverse, and globally competitive programs and services.
APPLYING FOR ADMISSION
Wayne County Community College District is an open admission institution and automatic for those who are 18 or years of age or older. Admission to specific programs is not automatic. For further information, please visit www.wcccd.edu or contact the Office of Admissions at 313-496-2600. If you are applying for financial aid to assist you in covering the cost of attendance, to be eligible for aid you must have a high school diploma or General Education Development (GED) Certificate. See our financial aid website for additional information.
For high school students under 18 years of age, the approval of a parent or guardian or the high school principal or counselor is required on the "Dual Enrollment" form. These forms are available at the Office of Admissions and Records at each campus.
Persons under age 16 must re-apply and be approved each semester for which they intend to enroll regardless of previous enrollments. Applications for persons under the age of 16 must be submitted to the District Office of Student Services, 801 W. Fort St., Detroit, MI 48226.
*Dual Enrollment classes may be available at no cost to the high school student who qualifies under the State School Aid Act, PA.148, Section 216. Students should contact their high school principal or counselor for information.
PROGRAM ADMISSION
Certain programs at the District have prerequisite courses and other criteria required for admission. In addition to meeting the official admissions/registration program requirements, students are required to apply for official program admission to their program of study. Students must complete an official Program Admission Form that may be obtained from the campus Student Services Office, the Office of Admissions or from the Campus Academic Officer. Additionally, to register for courses in technical degrees and certificate programs, except for specified introductory courses, students must have applied for and been accepted through the formal program admission process as specified in the District Catalog. Contact the Office of Admissions for specific program admission instructions.
For consideration of admission into ALL Allied Health programs, application deadlines are: May 15th for Fall and September 15th for Spring semesters.
Please Note: All students re-admitted to WCCCD after missing four or more consecutive regular semesters will be responsible for the curricula and regulations published in the current catalog and other official publications which are in effect at the time of their re-admission. In certain cases, dates of program admission may take precedence over dates of District admission for purpose of meeting program requirements for graduation.

APPLICATION FOR ADMISSION

LAST

FIRST

CURRENT ADDRESS AND PHONE NUMBERS

MIDDLE

NUMBER & STREET

CITY





HOME TELEPHONE NUMBER

STATE

ZIP CODE

Sign me up to receive Emergency Alerts

r Yes

r No

P.O. B0X OR APARTMENT






CELL NUMBER (EMERGENCY ALERT TEXT CONTACT)

E-MAIL ADDRESS

This section is optional and will not be considered in determining admissibility. Federal regulations do require WCCCD to report this.

SOCIAL SECURITY NUMBER

DATE OF BIRTH

GENDER









MM

DD

Y Y

r FEMALE

r MALE

Are you a veteran? r Yes V.A. certificate#

r No

Are you a resident in the WCCCD District? r Yes County of residence

r No

ETHNIC CATEGORY:
r Hispanic or Latino r Not Hispanic or Latino

Select one or more races to indicate what you consider yourself to be:

r African

r Asian/Pacific Islander

r African American

r Caucasian

r American Indian/ Alaskan Native
r Arabic

r Hawaiian/Pacific Islander r Other r No response

How long have you lived there?

RESIDENCY
Students residing in the College District will be charged resident tuition rates. The College District is defined as the whole of Wayne County with the exception of the following cities and townships: Dearborn, part of Dearborn Heights, Garden City, Highland Park, Livonia, Northville, Plymouth and part of Canton Township. Residency will be verified by voter registration card, driver's license, tax or rent receipts, or state identification card.

Are you a U.S. Citizen? Are you a permanent resident?

r Yes r Yes

r No r No

Country of Citizenship

Country of Birth

Is English your second language? r Yes If yes, what is your primary language?

r No

Type of Visa
Date of Visa
Visa # If you are a Naturalized U.S. Citizen, submit a photocopy of your Alien Registration Card with this application.

STUDENT TYPES

Check all boxes that apply
r New Student r Returning Student

r Guest Student r Transfer Student

r Virtual Learning Collaborative r Tech Prep r Dual Enrollment

When do you plan to enroll?

r Summer 20 _____

r Fall 20 _____

r Spring 20 _____

Preferred Campus r Downriver Campus r Northwest Campus

r Downtown Campus r Ted Scott Campus

r Eastern Campus r Mary Ellen Stempfle University Center

Preferred Program ________________________________________ r Associate
Degree

r Certificate

r Selected Courses
Only

PRIOR ACADEMIC HISTORY

List the last or current high school attended and all colleges, universities or other post-secondary educational programs attended.

NAME(S) OF HIGH SCHOOL(S), COLLEGE(S) OR GED CENTER (Attach additional sheets if necessary)
Did you graduate from high school? r Yes r No
Name of High School

MONTH

GRADUATION DATE DATE

YEAR

City and State
GED r Yes

r No

Did you take Tech Prep classes in high school? r Yes r No
If yes, which center?

College/University Name of College or University City and State

STUDENT’S SIGNATURE
I certify that all information on this form is complete and accurate. I understand that falsifying any part of this application may result in cancellation of admission, registration or both. If admitted to Wayne County Community College District, I will become knowledgeable of all College policies and regulations and will abide by them.

Student's signature

Date

NOTICE OF NON DISCRIMINATION - Any questions concerning Title IX of the Education Amendments of 1972 which prohibits discrimination on the basis of sex, or inquiries related to Section 504 of the Rehabilitation Act of 1973 which prohibits discrimination on the basis of handicap, and inquiries related to Title II of the Americans with Disabilities Act (ADA) which provides comprehensive civil rights protection for individuals with disabilities, or the College’s Statement of Compliance with Federal and State law, should be directed to Human Resources, Wayne County Community College District, 801 W. Fort, Detroit, MI 48226 or by calling: 313-496-2765.

Form 101 - 9/93, 4/94, 3/96, 7/99, 2/00, 11/03, 5/06 - 50000HDM, 7/08, 10/2009, 8/2018

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Application For Admission