Hutchinson Community College   

Application for Admission
(Note:  You must have an e-mail address to use this form)

Personal Information

Your application cannot be processed  without a valid SSN 

**Please check that you enter your SSN correctly.  An incorrect SSN can delay processing of your admissions and financial aid.**

Social Security Number:  (Ex: 111111111  NO DASHES)

                        MMDDYYYY             
Date of Birth:  (Ex: May 01, 1972 would be entered: 05011972  - NO DASHES) 

Last Name:     First Name:    Middle Name: 

Legal Address:    (A P.O. Box is not a legal address.)

City:      County:

State:      Zip Code: 

Daytime Phone # --        Alternate/Evening Phone # --

E-Mail Address: REQUIRED   Your confirmation will be e-mailed to you.

Who should we contact in case of an emergency:

Name            Phone #     --

The following information is used to monitor compliance with several federal and state statutes.  Your response is optional.

        Gender:  

        Ethnic Code: 

        Did your father or mother graduate from a four-year college or university? 

Residency Status

Note: If you are not a U.S. citizen or legal permanent resident, you must stop and
complete an international student application.

Are you a U.S. citizen?      

What is your status? 

Alien registration number  

 

Are you residing in Kansas

                                                          MMDDYYYY             
Date your Kansas residency began: (Ex: May, 01 1972 would be entered: 05011972) 


High School Information

High school last attended: 

City    State  County

High School Graduate 

Date of graduation:  Month Year  (Ex: 1972)

Anticipated graduation date:  Month Year   

Have you passed the GED?    

If you have passed the GED, please indicate the date that you took the exam
 MMDDYYYY   
(Ex: May, 01 1972 would be entered: 05011972) 

Enrollment Information

(Select One)
               
     *Note: A permission form must be completed by your high school principal.

If you are a former HCC student,                                   YYYY
please indicate date of last attendance (Ex: 1972)


What term do you plan to take classes at HCC:                

Which of the following best describes your reason for attending HCC?

     

What is your intended major or field of study?
1st Choice 
          

2nd Choice 
        

Are you seeking a degree or semester length certificate from HCC?      (Only degree or certificate seeking students are eligible for Federal Financial Aid and for participation in HCC student activities.)

*If you are a degree seeking student, you are required to submit official transcripts, including High School/GED and any College/Technical Schools you have attended.  It is your responsibility to make sure that each transcript is sent directly to Hutchinson Community College.  If all official transcripts are not on file in the Registrar's Office, a hold will be placed on your records.  Hand carried copies are not acceptable.

 


If you are not seeking a degree or semester length certificate from HCC, you may skip this section and proceed to the Student Certification.

Previous College(s)/Educational Experiences

Select Yes or No for the following questions:

Have you attended other colleges, universities, or vocational schools?   

Do you have a bachelor's degree or higher?   

Are you currently on Academic Dismissal from another college?   

List the name, city and state, dates of attendance and hours for all colleges previously attended for credit courses in order of attendance.  

 Name of School  #1        State     #of hours earned       Dates attended 
                                                                                             (mmyyyy)          (mmyyyy)
             From ToEx:051999

 Name of School  #2         State    #of hours earned       Dates attended 
                                                                                             (mmyyyy)          (mmyyyy)
             From ToEx: 051999

 Name of School  #3         State    #of hours earned       Dates attended 
                                                                                             (mmyyyy)          (mmyyyy)
             From ToEx: 051999


Student Certification

This admission form will not be processed unless you complete the Date, Name, and E-mail Address boxes below.

By entering my name and E-mail in the block below, I certify that all the answers I have given in this application are accurate to the best of my knowledge.  I understand that failure to disclose or falsifying information could result in my dismissal from Hutchinson Community College.

Name:   

E-Mail Address: 


Form Submission
Complete and submit the Application for Admission form.  After your admission form has been processed the Admissions Office will e-mail your acceptance verification.  

**Before clicking SUBMIT, please take a moment to verify you have entered your correct SSN**

   

Notice of Non-Discrimination: Applicants for admission and employment, students, employees, sources of referral of applicants for admissions and employment, and all unions or professional organizations holding collective bargaining or professional agreements with Hutchinson Community College are hereby notified that this institution does not discriminate on the basis of race, color, religion, national origin, sex, age, or disability in admission or access to, or treatment or employment in, its programs and activities.

If you need additional information on Hutchinson Community College, contact the Admissions Office.