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College and Term

College *

San Diego City CollegeSan Diego Mesa CollegeSan Diego Miramar College

Semester *

Fall 2017Spring 2018Summer 2018

Program of Study *

3ACCYTAGES - Accountancy3AJCSSPGES - ADJU - Court Support3AJCTECGES - ADJU - Correctional Tech3AJINVEGES - ADJU - Investigations3AJLENFGES - ADJU - Law Enforcement3AJPTECGES - ADJU - Contemp Police Tech3AMTAIRGES - AVIM - Airframe3AMTAPLGES - AVIM - Airframe & Powerplant3AMTGENGES - AVIM - Aviation Gen Studies3AMTPPLGES - AVIM - Powerplant3AOMGPTGES - AVIA - Management/pilot3AOMGTMGES - AVIA - Management3AOPLTLGES - AVIA - Pilot3AOPPILGES - AVIA - Professional Pilot3ARTCDPGEA - Art-Fine Art - Comb Draw/Paint3ARTCRFGEA - Art-Fine Art - Craft Skills3ARTSTDGEA - Art/Visual Studies3ARTSTUGEA - Art-Fine Art - Studio Arts3AUTOGYGES - Automotive Technology3AVIABAGES - Aviation Business Admin3AVIAPAGES - Professional Aeronautics3BANKINGES - Bus Mgt-Mortgage Broker & Bank3BIOAPPGES - Biology-Applied Biology3BIOAPTGES - Biology-Applied Biology3BIOHLTGES - Biology - Allied Health3BIOLSTGES - Biology Studies3BUSADMGES - Business Administration3BUSMGTGES - Business Management3CBTAASGES - CBT-Administrative Assistant3CBTADSGES - CBT-Administrative Assistant3CBTMAPGES - CBT-Microcomputer Applications3CBTMCAGES - CBT-Microcomputer Applications3CDSSUPGES - Child Dev - Site Supervisor3CHEMSTGES - Chemistry Studies3CHILDVGES - Child Development3CISCIEGES - Computer & Info Sciences3COMMSTGEA - Communication Studies3DTHDTTGES - DIES - Heavy Duty Tran Tech3DTHETYGES - DIES - Heavy Equipment Tech3EARTHSGES - Earth Science Studies3ELEMEDGEA - Elementary Education3ENGCTYGEA - English3ENGLISGEA - English3FTADMIGES - FIPT - Fire administration3FTDROPGES - FIPT - Driver Operator3FTLFGPGES - FIPT - O/W Lifeguard Prof3FTOFCRGES - FIPT - Fire Officer Cert3FTPROTGES - FIPT - Fire Protection3FTPRVNGES - FIPT - Fire Prevention3FTRESUGES - FIPT - Rescue3FTTECHGES - FIPT - Fire Technology3GRAPHSGEA - Graphics3HDEVSTGEA - Human Development Studies3HLPESTGES - Health & Physical Educ Studies3HUMASTGEA - Humanities Studies3LART-1GEA - Liberal Arts-Option I3LART3CGEA - Lib Arts-Opt III (IGETC CSU)3LART3UGEA - Lib Arts-Opt III (IGETC UC)3LARTIIGEA - Liberal Arts-Option II3LEGLASGES - Legal Assistant3LITESTGEA - English/Literature Studies3MATHSTGEA - Mathematics studies3MILISTGES - Military Leadership3MLTTECGES - Medical Laboratory Technology3MUSISTGEA - Music Studies3OTECSTGES - Occupational/Technical Studies3PARALEGES - Paralegal3PENSTDGES - Pre-Engineering Studies3PHYSTDGES - Physics Studies3PILOTPGES - AVIM - Private Pilot Studies3PILOTSGES - AVIM - Pilot Studies3PSYCGYGEA - Psychology3SBESCIGEA - Social & Behavioral Sciences3SDCCSEGES - SD City Civ Ser-Equip Mech App3SDTGENGES - SD Transit-Gen Mechanic App3SLCTSTGEA - Selected Studies3TRFCS6GEA - Transfer Studies - CSU3TRFIC6GEA - Transfer Studies - IGETC CSU3TRFIU6GEA - Transfer Studies - IGETC UC3TRFOT6GEA - Transfer Studies - Other3TRFTA6GEA - Transfer Studies - TAG3WLANGSGEA - World Language StudiesGE2_CSUGE - Transfer to 4Yr UnknownHIGHSCHOOL - High SchoolGE2_CSUGE - Undeclared (Not Eligible for Financial Aid)

Educational Goal *

A - Obtain an associate degree and transfer to a 4-year institutionTransfer to a 4-year institutions without an associate degreeObtain a 2-year associate degree without transferEarn a career technical certificate without transferDiscover/formulate career interests, plans, goalsPrepare for a new career (acquire job skills)Advance in current job/career (update job skills)Maintain certificate or licenseEducational developmentImprove basic skillsComplete credits for high school diploma or GEDMove from noncredit coursework to credit coursework4 year college student taking courses to meet 4 year college requirementsUndecided on goal

Student Information

Last Name *

First Name *

Middle Name

Suffix

JrSrIIIIIIIV

Previous Name

Other Last Name

Other First Name

Other Middle

Permanent Address *

Apt, suite, etc.

CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin Islands

Zip code

Mailing same as Permanent?

Yes

Mailing Address

Apt, suite, etc.

CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin Islands

Zip code

Main Phone

Text Authorization

Yes

Secondary Phone

Text Authorization

Yes

Email *

SSN/ITIN

Type

SSN

ITIN

Birth Date *

Gender

Male

Female

Martial Status

SingleMarriedDeclined to State

Dependent Status

Dependent

Independent

Parent/Guardian 1 Education

Some High SchoolHigh School/GEDSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreeDoctoral DegreeProfessional Degree

Parent/Guardian 2 Education

Some High SchoolHigh School/GEDSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreeDoctoral DegreeProfessional Degree

Hispanic

Hispanic

Not Hispanic

Decline to State

Ethnicity

Asian: Indian

Asian: Chinese

Asian: Japanese

Asian: Korean

Asian: Laotian

Asian: Cambodian

Asian: Vietnamese

Asian: Filipino

Asian: Other

Black of African American

American Indian/Alaskan Native

Pacific Islander: Guamanian

Pacific Islander: Hawaiian

Pacific Islander: Samoan

Pacific Islander: Other

White

Mexican, Mexican-American, Chicano

Central American

South American

Hispanic: Other

Education Information

Enrollment Status *

First-time student in college (after leaving high school)First time at this college; have attended another collegeReturning student to this college after absent for a main termEnrolling in high school (or lower grade) and college at the same time

High School Education Level

Not a graduate of, and no longer enrolled in high schoolWill be enrolled in high school (or lower grade) and college at the same timeCurrently enrolled in adult schoolReceived high school diploma from U.S. schoolPassed a high school equivalency test and received a certificate of high school equivalencyReceived a Certificate of California High School ProficiencyReceived a diploma/certificate of graduation from a Foreign secondary school

High School Completion Date

Highest Education Level

Some High SchoolHigh School/GEDSome CollegeAssociate's DegreeBachelor's DegreeMaster's DegreeDoctoral DegreeProfessional Degree

Last High School Attended

Bonita VistaCastle ParkChula VistaClairemontCoronadoCrawfordGarfieldGompersGranite HillsGrossmont HighHelixHenryHilltopHooverKearnyLa JollaLincolnMadisonMar VistaMira MesaMission BayMonte VistaMontgomeryMorseMount MiguelMt. CarmelPoint LomaPowayRancho BernardoSan Diego HighScripps RanchSDC&PASerraSouthwestSweetwaterUniversity CityHealth Science High & Middle CollegeCanyon Crest AcademyCharter School of San DiegoHigh Tech HighHigh Tech High Int'lHigh Tech High Media ArtSan YsidroWest ViewMonarchOlympianOtay RanchEastlakePruessDel Norte HighS.D. Continuing Education CenterForeign HSOut of State HSOther

Other California H.S. Name

Graduated from CA High School

Yes

No

Attended HS in CA for 3 Years

Yes

No

Number of Colleges Attended

None

1

2

3

4

Expelled from College?

Yes

College 1

College Name

Cal State San MarcosChapmanCuyamacaGrossmontMira CostaNational UniversityPalomarPoint LomaSDSUSDSU ExtensionSouthwesternUCSDUCSD ExtensionUSDUSIUAlliant Int'lOther

Other College Name

Start Date

End Date

Expelled?

Yes

Degree Obtained

No DegreeAssociate DegreeBachelor Degree or HigherCertficiate

Date Conferred

College 2

College Name

Cal State San MarcosChapmanCuyamacaGrossmontMira CostaNational UniversityPalomarPoint LomaSDSUSDSU ExtensionSouthwesternUCSDUCSD ExtensionUSDUSIUAlliant Int'lOther

Other College Name

Start Date

End Date

Expelled?

Yes

Degree Obtained

No DegreeAssociate DegreeBachelor Degree or HigherCertficiate

Date Conferred

College 3

College Name

Cal State San MarcosChapmanCuyamacaGrossmontMira CostaNational UniversityPalomarPoint LomaSDSUSDSU ExtensionSouthwesternUCSDUCSD ExtensionUSDUSIUAlliant Int'lOther

Other College Name

Start Date

End Date

Expelled?

Degree Obtained

Date Conferred

College 4

College Name

Cal State San MarcosChapmanCuyamacaGrossmontMira CostaNational UniversityPalomarPoint LomaSDSUSDSU ExtensionSouthwesternUCSDUCSD ExtensionUSDUSIUAlliant Int'lOther

Other College Name

Start Date

End Date

Expelled?

Degree Obtained

Date Conferred

Citizenship/Visa Information

Citizenship Status *

US CitizenPermanent ResidentTemporary Resident / AmnestyRefugee / AsyleeOther

Visa/Permit Information

Alien Registration Number

Expiration Date

Issue Date

No Documents

Yes

No Expiration Date

No Expiration Date

Military/Veteran

Military Status

None ApplyCurrently serving on active dutyParent/guardian/spouse is currently serving on active dutyServed in the US military (veteran)Parent/guardian/spouse served in US militaryMember of the Active ReserveParent/guardian/spouse is member of Active reserveMember of National GuardParent/guardian/spouse is member of National Guard

Military/Veteran Information

Discharge Date

Discharge Type

HonorableEntry Level Separation (ELS)GeneralOther Than Honorable (OTH)Clemency DischargeBad Conduct (BCD)Dishonorable

Military Legal Residence

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Military Home State

AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY

Military Home Country

United States (US)United Kingdom (UK)CanadaAustraliaAfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe

Stationed in CA?

Yes

No

Stationed in CA for Education?

Yes

No

Branch of Service

No or Decline to StateNot Active Duty - VeteranAir ForceArmyCoast GuardMarinesNavyOther

Residency Information

California Resident for at least 2 Years?

Yes

No

Date Current Stay Begin

Not Yet Arrived in CA

Yes

CA College Employee?

Yes

No

CA School Employee

Yes

No

Seasonal Ag Worker

Yes

No

Foster Youth?

Yes

No

Foster Youth Status

Currently in foster careAged out of foster careExited out before 18Not sure of age of exit

Outside State Taxes

Yes

No

Year

Voted Outside CA?

Yes

No

Year

Outside College?

Yes

No

Year

Outside Lawsuit

Yes

No

Year

Comfortable with English?

Yes

No

Athletic Interest?

Yes

No

Financial Assistance?

Yes

No

TANF/SSI?

Yes

No

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