Application
for Admission
Doņa Ana Community College
MSC-3DA · P.O. Box 30001 · Las Cruces, NM 88003-8001
Telephone: 505 527-7710
Fax: 505 527-7763
Application
for Admission |
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| Campus: Las Cruces Sunland Park Gadsden White Sands |
| PLEASE FILL IN ALL SECTIONS | Social Security Number |
| Last Name | First Name | Middle Name |
| Current Mailing Address | Apt., Room, Space No. |
| City | State | ZIP Code | Telephone Number - - (Area Code) |
| Please enter your Email address: |
| Parent, Legal Guardian, Check only if you don't have a parent or legal guardian. Emergency Contact: |
| Last Name | First Name | Phone Number - - (Area Code) |
| Address | City | State | ZIP Code |
| Sex: Male Female Date
of Birth
- -
Month Day Year |
| RESIDENCY: State of Legal Residence County of Legal Residence |
| Length of time, preceding date of this application, that applicant has resided CONTINUOUSLY in New Mexico | Years |
Months |
Days |
| If less than 23 years of age, were you reported as a dependent on
parent or guardian's federal income tax return for previous year? Yes No |
| ETHNICITY: This
information is requested by government agencies to demonstrate compliance with the Civil
Rights Act. Please check the block designating your predominant ethnic background.
(optional) American Indian or Alaskan Native Black, non-Hispanic White, non-Hispanic Asian or Pacific Islander Hispanic Race/ethnicity unknown |
CITIZENSHIP: U.S. Citizen
Foreign
Permanent
Resident Visa Number |
| ENROLLMENT STATUS (check one) (NS)
First enrollment in ANY college or university |
| Semester Applying For: Fall
20
Summer I
20 Spring 20 Summer II 20 |
| Associate Degree Programs Automotive
Technology |
Electronics Technology Emergency Med. Svcs. Facilities Maint. Tech. Fire Science Technology General Studies Heating, A/C & Refrig. Hospitality Services Legal Assistant Library Technology Manufacturing Tech. |
Nursing Pre-Business Radiologic Technology Respiratory Care Retail Mktg. & Merch. Water Technology Welding Technology Youth & Adolescent Para. Undecided |
| Certificate Programs Automotive
Technology |
EMS/Emergency Med. Serv. Facilities Maint. Tech. Health Care Assistant Heat., Air Cond. & Refrig. Retail Mktg. & Merch. Water Technology Welding Technology Undecided |
| Selective Programs Area
Vocational School |
| HIGH SCHOOL LAST ATTENDED: Name of School City State |
| Date graduated, or will graduate from high school Month Year |
| If not a high school graduate, give date of G.E.D. Test |
| If last name(s) at time of attendance at high school and/or previous college(s) is different from the last name given above, please indicate name(s) under which you were registered: |
| LIST ALL COLLEGES OR UNIVERSITIES YOU HAVE ATTENDED OR ARE NOW
ATTENDING. Academic regulations require that students who have registered at other colleges or universities may not disregard their records at such institutions when making application for admission to DACC. Students concealing attendance at another college or university and not submitting a transcript from that college or university will be SUBJECT TO SUSPENSION. |
COMPLETE NAME OF INSTITUTION(S) |
FROM (mo.& yr.) |
TO (mo. & yr.) |
LOCATION(S) |
ADM ONLY |
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| Are you eligible to return to the last college or university attended? Yes No Not Applicable |
| Have you been awarded a university degree Yes No |
| If yes, give degree Year Granting Institution |
| American College Testing (ACT) or Computer Placement
Assessment and Support System (COMPASS) Program Data
Although American College Test (ACT) scores are not required for admission, students are encouraged to test and request their scores be sent to the DACC Admissions Office. Students who do not take the ACT, may be required to take the COMPASS test prior to admission to DACC. The COMPASS is administered at DACC free of charge. Please call for an appointment. |
| I understand that withholding information requested in this
application, failure to submit all required documents, or giving false information may
make me ineligible for admission to or continuation at Doņa Ana Community College.
I understand I will be required to sign this application prior to registering. ( A $15 nonrefundable fee will be assessed ) |