CENTRAL NEW MEXICO COMMUNITY COLLEGE

ADMISSION FORM

Please print all information. Use black or blue ink only.

1. Student ID Number ______2. Application for o (1) Fall o (2) Spring o (3) Summer 20______

3. PRINT full legal name ______

Last First Middle

4. Other names used ______

Last First Middle

5. Telephone number Home (______) ______- ______Work (______) ______- ______

6. Mailing Address ______APT/SP#______

______

City State Zip Code

7. Permanent Address (if different than above) ______APT/SP#______

cannot be a PO Box

______

City State Zip Code

8. Email Address______o Personal o Business

9. Social Security Number ______- ______- ______10. Gender* o Male o Female 11. Date of Birth* ______/______/______

Month Day Year

12. Ethnic origin* o (1) American Indian/ Alaskan native o (2) Asian American/Pacific Islander o (3) Black, non-Hispanic

o (4) Hispanic o (5) White, non-Hispanic o (6) Other

13. Citizenship (check all that apply) o United States citizen If no, give country of citizenship ______

oNonimmigrant Visa Type______(Provide documentation) o Other category

o Resident Alien o Permanent Resident o Applicant for Permanent Resident (Provide documentation)

Alien Registration No.______Expiration date______

14. Enter the alpha code of your intended major(s) and concentration(s) numeric code (if applicable). Codes are printed in the Getting Started At CNM brochure.

(a) 1st Major Code ______o Certificate o Associate Degree Concentration(s) (if applicable) A. ______B. ______

(b) 2nd Major Code (optional) ______o Certificate o Associate Degree Concentration(s) (if applicable) A. ______B. ______

15. What is your educational goal at CNM? (Check primary reason) o (1) Certificate o (2) Associate Degree o (3) Personal development

o (4) Skill upgrade/development o (5) Transfer credits to another college

16. Admission Classification o (1) First time enrolling for credit at CNM or any college

o (2) Returning to CNM after an absence (previously enrolled in CNM credit courses)

o (3) New to CNM with prior college coursework

17. High school diploma o Yes o No Name of School______State______Graduation Date ______/______

Month Year

18. GED o Yes o No GED Testing Center______State______GED Date ______/______

Month Year

19. List all technical schools, colleges and universities you attended. Include enrollment at CNM in credit courses/programs.

Full Name of School / City and State / Years Attended / Type of Certificate or
Degree Awarded

20. Marital Status* o Unmarried o Married o Separated 21. Is English your primary language?* o Yes o No

22. Did either of your parents graduate from a 2-year college or 4-year college or university?* o Yes o No

You must complete questions 23-35 to be considered for in-state tuition classification. Failure to do so will result in an automatic non-resident tuition classification.

23. Have you lived in New Mexico for the past 12 consecutive months? o Yes o No

If no, please explain ______

24. Are you a registered voter? o Yes o No State ______NM County: o Bernalillo o Sandoval o Valencia o Other______

25. Do you have a current driver’s license? o Yes o No If yes, give state of license ______

26. Do you have a current state issued ID card (other than driver’s license)? o Yes o No If yes, give state of ID ______

27. Do you have a vehicle registered in your name? o Yes o No If yes, give state(s) of registration ______

28. Did you file a New Mexico personal income tax report for the immediate preceding year? o Yes o No

29. If younger than 23 years of age, did your parent(s) or legal guardian claim you as a dependent on their federal tax return in the

immediately preceding tax year? o Yes o No

If yes, have your parents/guardians lived in New Mexico for the past 12 consecutive months? o Yes o No

(A duplicate copy of pages one and four of the 1040, 1040A or 1040EZ and additional documentation may be required.)

30. New Mexico is my home and I am not a resident of any other state o Yes o No

31. Are you a member or spouse or dependent of a member of the armed forces or National Guard, on active duty, stationed in New Mexico? o Yes o No

(An Active Duty Military Tuition Residency Form may be required)

32. Are you an enrolled member of an American Indian nation, tribe or pueblo located wholly or partially within the State of New Mexico? o Yes o No

List nation, tribe or pueblo ______(Proof of membership may be required)

33. Did you attend a New Mexico high school for at least one (1) year? o Yes o No

34. List names of employers, locations and dates of employment during the past two years:

Employer /
City and State
/ Dates of Employment

I certify that the information on this admission form is complete and correct. I understand that information submitted herein will be used in determining my status for admission and residency eligibility. I understand that I may request, at the time of admission, not to use my Social Security Number as my CNM student number. I authorize CNM to verify the information I have provided. I understand that nondisclosure or misrepresentation in filling out the admission form will be considered grounds for denial of admission, cancellation of registration or suspension. I agree to notify the Admission and Records Office of any changes in the information provided and to conform and abide by the letter and spirit of all rules, regulations and procedures of CNM as stated in the CNM Catalog and Schedule of Classes.

______

APPLICANT’S SIGNATURE DATE

*Voluntary information used to comply with federal and state reporting and having no effect upon admission to CNM. It is the policy of CNM not to discriminate on the basis of gender, race, color, national origin, religion, age, disability, sexual orientation, marital status or ancestry in any of its practices or procedures.

Albuquerque, New Mexico

Main Campus, 525 Buena Vista SE, 87106

Joseph M. Montoya Campus, 4700 Morris NE, 87111

South Valley Campus, 5816 Isleta SW, 87105

Westside Campus, 10549 Universe Blvd. NW, 87114

Information Line

(505) 224-3160

1-888-453-1304 (outside Albuquerque calling area)

CNM website – www.cnm.edu

dtFeb08