JamesSpruntCommunity College
PO Box 398, Kenansville, North Carolina28349
APPLICATION FOR ADMISSION AS A CAREER AND COLLEGE PROMISE STUDENT
CAREER AND TECHNICAL EDUCATION PATHWAY
ADMISSION POLICY
It is the policy of JamesSpruntCommunity College not to discriminate against any person on the basis of race, color, sex, religion, age, or national origin in the recruitment and admission of students.
Information supplied on this application is in no way used as a criteria for admission. It is used for institutional statistical purposes and is held in strict confidence. Please notify the Admissions Specialist if any information that is supplied on this application changes.
JamesSpruntCommunity College
MISSION STATEMENT
James Sprunt is a comprehensive, open door community college that responds to the needs of Duplin and surrounding counties by enabling a diverse population of adults to attain their personal, academic and career goals; by collaborating and partnering with area businesses and industries in meeting their training and retaining needs; by enhancing the educational, cultural, and economic development of the service area; and by improving the quality of life in the community.
APPLICANT INFORMATION
Social Security Number: ______(For reporting purposes only.)
Name: Last ______First ______Middle/Maiden ______
Mailing Address: ______Home Phone _____-______-_____
Street, P.O. Box,
______Work Phone _____-______-_____
City
______
StateZip
Sex: ____M ___F Date of Birth: ______
Ethnicity: Are you Hispanic/Latino? ____ YES (HIS) ___ NO (NHS)
Individuals who are non-Hispanic/Latino select ONE or MORE races:
___ American Indian or Alaska Native (AN) ___ Asian (AS) ___ Black or African American (BL) ___ Native Hawaiian or Other Pacific Islander (HP) ___ White (WH)
State of Residence: ____ NC (If not NC, enter state) ___ County of Residence if NC Resident ______
Employment while attending JSCC: ___ Unemployed-Not seeking employment
___ Unemployed-seeking employment ___ Employed 1-10 hrs/wk ___ Employed 11-20 hrs/wk
___ Employed 21-39 hrs/wk ___ Employed 40-more hrs/wk
Student Status: ___ Freshman___ Returning Student
PATHWAYS - Please choose only one:
______C25100HS – Accounting Cert.______C55180HS – Criminal Justice Cert.
______C30100HS – Advertising & Graphic Design Cert.______C55220HS – Early Childhood Cert.
______C15100HS – Agribusiness Technology Cert.______C45400HS – Med. Assist.–Health Care Worker Cert.
______C15280HS – Applied Animal Science Tech. Cert.______C25370HS – Office Administration Cert.
______C25120HS – Business Admin. Cert.______C55440HS – School Age Education Cert.
______C25260HS – Computer Info. Tech. Cert.______C50420HS – Welding Tech. Cert.
Goals: Please indicate your long-term goals.Semester: When do you plan to enter?
___ Obtain Associate Degree, Diploma or Certificate___ Summer ___ Fall ___ Spring _____ Year
___ Enhance my job skills in my present field of work
___ Enhance my job skills for a new line of workCitizenship: ____ U.S. Citizen ___ Non-Immigrant Alien
___ Take courses to transfer to another college ____ Permanent Resident Alien
___ Take courses for personal interest
If not a U.S. Citizen, Name of Country ______
Type of Work: ______
Employer: ______
HIGH SCHOOL INFORMATION
Name of High School Last AttendedCounty in which school is locatedState located
______
Anticipated Graduation DateDate of Last AttendanceHighest Grade CompletedHigh School Program Track
_____Mo. ______Year_____Mo. ______Year______College Prep ___ Tech Prep
___ General/Other
REPORT OF MEDICAL HISTORY
Name of person to contact in case of emergency: ______
Address: ______
Relationship to you: ______Telephone No. ______
Are you allergic to any medication or materials? ______Yes_____ No
If yes, explain: ______
PERSONAL HISTORY: Please indicate in the space below any conditions, ailments or problems which you feel may be helpful for college officials to know in the event you were to have an accident, illness or other emergency health problem while on campus.
If you are physically unable to participate in physical education activities, you must submit medical documentation to the College Transfer Department Head in order to have the requirement waived.
If student requires emergency medical treatment, the College is authorized to take the student to the nearest medical facility or to contact local rescue personnel.
CERTIFICATION
I certify that these responses are true to the best of my knowledge, pursuant to reasonable inquiry where needed, and I am aware that any knowing falsification of this application or any subsequent documentation require by the College or its departments may result in disciplinary action, including denial of admission or dismissal after admission.
Signature of Applicant: ______Date: ______
Effective Fall 2013