CCSF Noncredit Application

NON-CREDIT APPLICATION FOR ADMISSION
50 Phelan Avenue, Smith Hall, Room 118B, San Francisco, CA. 94112

PLEASE COMPLETE THE ENTIRE APPLICATION IF YOU ARE A NEW STUDENT.

Semester:
Fall
Spring
Summer

Campus you would like to attend:
Alemany Downtown Mission
Chinatown/North Beach Evans Ocean Ave.
Castro/Valencia John Adams Southeast

1. IDENTIFICATION

Student ID / Social Security Number - - (Optional) Be sure your Social Security Number is accurate as it is used as part of your permanent record. If you do not have a Social Security Number, leave blank and you will be assigned a Student Identification Number
Last Name First Name Middle Email
Previous Name Last Name First Name Middle
Mailing Address Number and Street Apt. # City State Zip Code -
Permanent Address (if different) Number and Street Apt. # City State Zip Code -
Home Phone () -	Work Phone () -
Sex Male Female	Birthdate:
Contact via: Email Phone U.S. Mail Text messaging (Standard text messaging rates apply) Cell phone number: - - Cell phone provider:

2. ETHNICITY

What is your Ethnicity?

3. VOTER REGISTRATION

I am a U.S. citizen and want to register to vote, or I have recently moved and need to re-register.
Please send me voter registration/education information. Yes No

4. EDUCATION

What is your long term Educational Goal?

What is the Highest Educational Level You Have completed?
Year Received

Is English Your Primary Language? Yes No

5. EMERGENCY CONTACT

Last Name First Phone () -
Number and Street Apt. #
City State Zip Code -

6. NON-DISCRIMINATION POLICY

All programs and activities offered by City College of San Francisco shall be performed in a manner which is free of discrimination on the basis of race, color, national origin, ancestry, religion, creed, sex, pregnancy, marital status, sexual orientation, disability or veteran status.

7. INFORMATION RELEASE

Can Directory Information^* be released to the public, Federal, State and Local governmental agencies without your written consent? Yes No
* Directory Information is defined as information contained in an educational record of a student which would not generally be considered harmful or an invasion of privacy if disclosed. It includes, but is not limited to the students's name, address, telephone listing, date and place of birth, level of education, major field of study, participation in officially recognized activities and sports, weight and height of members of athletic teams, dates of attendance, degrees and awards received, and the most recent previous educational agency or institution attended.
(Note: The above listing of Directory Information may be revised as Federal and/or State Regulations change. A listing of Directory Information is located in the City College Catalog and Schedule of Classes. The college assumes no liability for honoring a student's request that such information be withheld.)

8. INSTITUTIONAL FUNDING INFORMATION

City College receives additional assistance to support our educational programs and financial aid for students. How much we receive is dependent upon certain information we provide our students, their background, income levels, and experiences. Please complete this section to help us receive our "fair share." All information is voluntary and is strictly confidential.

1) Would you classify yourself as economically disadvantaged? Yes No
2) What is your annual household income?
3) How many dependents are in your family including yourself?
4) Are you a recipient of CALWORKS (formerly AFDC)? Yes No
5) Are you a recipient of the Supplemental Security Income Program (SSI)? Yes No
6) Are you a recipient of General Assistance Program (GA)? Yes No
7) Are you a single parent? Yes No

9. STUDENT SIGNATURE

I declare that the foregoing statements of fact provided by me on this form are true and correct.