Clinton Junior College

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Please complete the following information. This Application should be submitted with a nonrefundable $25 application fee, unless you are applying for readmission. Please answer or complete every item in each section to avoid a processing delay. You may pay via postal or bank money order, cashier's check, cash or certified check.

Office Use Only:
Date Application Received:
Application Fee/Waiver:

Complete each field where applicable

I. Personal Information
First Name:	Middle Name:	Last Name:
Social Security #: (999-99-9999) Required for US Citizen & Resident for processing	Date Of Birth (mm/dd/yyyy)	Gender: Male Female
Place of Birth State: County:	Ethnic Information: Black Non-Hispanic Hispanic Asian African Native American Multi-Racial White Non-Hispanic	Criminal Convictions: Yes No If yes please explain:
Citizenship: US Citizen Foreign National US Resident Foreign National Non-Resident Alien		If not US citizen please name your home country:
Marital Status:	Resident Of SC Yes No	County of Residence

Denomination:
Home Church/City/State:
Your Email address:(if available) Carefully enter email address and CHECK FOR ACCURACY

II. Enrollment Information/Major
How did you learn about Clinton Junior College?	Are you a '1st-generation' college attendee? Yes No
Intended Degree: Application Type	Intended Major:
Term Applied For:	Prior Student #(If Any)
I will be primarily a: Day Student Evening Student	I will attend: Full Time (12 hrs) Part Time (less than 12 hrs)
I will be a: Resident Student Commuting Student

III. High School Information

High School Last Attended	City	State	Graduation Date
Highschool GPA (Freshman Only)	Cumulative GPA (Transfer Only)	Which of the following test have you taken: ACT SAT Approx. Test Date:

IV. Mailing Address Information

Present Mailing Address

Street:

APT./C.O.:

City:

State: ZIP:

Country:

Telephone Number:

Permanent Mailing Address

Street:

APT. / C.O.:

City

State: ZIP

Country

Telephone Number

V. Emergency Contact

Name:	Number:	Relationship:

If a prior name was used while attending Clinton Junior College please list it here:

Please list all Community Colleges/Colleges, Cities, States and dates of attendance, declared majors,
degrees/certificates and graduation dates below:

Name of Institution

City

State

Major

Degree/Cert

Grad Date
(mm/dd/yy)

Please have official transcripts from all other Colleges/Institutes attended sent to:
Office of Enrollment Management,
Clinton Junior College, 1029 Crawford Rd, Rock Hill, SC 29730
1 (877) 837-9645 - toll free
(803) 327-7402 Ext 222 - Office
(803) 327-3261 - Fax
www.clintonjuniorcollege.edu

I understand that withholding information requested in this application or giving false information may make me ineligible for admission to or continuation in Clinton Junior College. With this in mind, I certify that all information is true, correct and complete. Further, if I am admitted, I agree to abide by the rules and regulations of the College

Press the button below to SUBMIT your application - By doing so you are agreeing to the terms and conditions stated above.

Clinton Junior College is committed to equal opportunity in employment and education. The College does not discriminate in any program including admission of students and employment on the basis of race, color, national origin, sex, religion, age or handicap.

1029 Crawford Road
Rock Hill, SC 29730
Phone: (803) 327-7402
Fax: (803) 327 3261
1-877-837-9645 - Toll Free
Phone Extensions

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