Application for Readmission
ADMISSIONS OFFICE · MSC-3DA · P.O. Box 30001
Las Cruces, NM 88003-8001
Telephone: 505.527-7710 · Fax: 505 527-7763

DACC
PLEASE FILL IN ALL SECTIONS

 

SOCIAL SECURITY NUMBER:
Last Name First Name Middle Name

Current Mailing Address (Street and Number/Box Number)
Apartment, Room, Space Number
City State ZIP Code Telephone number - -
                                    (area code)
Please enter your Email address:
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 dependent on parent or guardian's federal income tax return for previous year?
Yes No
RACE/ETHNICITY:  This information is requested by government agencies to demonstrate compliance with the Civil Rights Act.   Please check the block designating your predominant racial/ethic background. (optional)
American Indian or Alaskan Native     Asian or Pacific Islander
Black, non-Hispanic     Hispanic     White, non-Hispanic      Other/unknown
CITIZENSHIP:      U.S. Citizen     Permanent Resident      Foreign
Permanent Visa Number: (An official copy of form I-551 is required for admission to DACC)
APPLYING FOR:          Fall 20      Spring 20     Summer I, 20     Summer II, 20
CAMPUS WHERE YOU PLAN TO ENROLL:
Las Cruces     Gadsden      Sunland Park     White Sands
PREVIOUS ATTENDANCE AT DACC OR NMSU:
From:
             semester/year		 To:
         semester/year
Campus Last Attended:
Intended program of study:
                                                                   Indicate Major
SPECIAL ADMISSION PROGRAMS:      Nursing - Associate Degree      Radiologic Technology     EMS - Advanced
                                                                             Electrical Apprenticeship     Respiratory Care
                                                                              (Contact the specific program for additional information and deadlines.)
LIST ALL COLLEGES OR UNIVERSITIES YOU HAVE ATTENDED OR ARE NOW ATTENDING.    Official transcripts must be mailed directly from the college or university previously attended to the DACC Admissions Office.  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 Location(s) From (mo./yr.) To (mo./yr.)
1.)
2.)
3.)
4.)
5.)
6.)
If last name(s) at time of attendance at high school and/or previous institution(s) of higher education is different from the last name given above, please indicate name(s) under which you were registered:
Are you eligible to return to the last college or university attended?        Yes      No     Not Applicable

Have you been awarded a college or university degree?      Yes        No
If YES, give degree:   Year:
Granting Institution:
I understand I will be required to sign this application prior to registering.