Transcripted Credit Enrollment Form

STUDENT IDENTIFICATION

LEGAL FIRST NAME

LEGAL LAST NAME

MIDDLE NAME

PREFERRED FIRST NAME

EMAIL

CONFIRM EMAIL

PREFERRED PHONE TYPE

HOME PHONE

CELL PHONE

HOME ADDRESS

CITY

COUNTY & MUNICIPALITY

STATE

ZIP CODE

GENDER ASSIGNED AT BIRTH

CITIZENSHIP

DATE OF BIRTH

SOCIAL SECURITY NUMBER (SSN)

Ethnicity

American Indian or Alaska NativeYesNo

AsianYesNo

Black or African AmericanYesNo

Native Hawaiian or other Pacific IslanderYesNo

WhiteYesNo

HIGHEST GRADE COMPLETED

GRADUATION YEAR

CRN NUMBER

CVTC COURSE NAME

ENTRY TERM

HAVE YOU TAKEN ANY CLASSES FROM CVTC BEFORE?

Student Signature