Admissions Application Request - Main Form

Contact Information
Personal Information
Additional Information
Parent Information
Academic
Additional Information

is required

is Required

First Name
Middle Name
Last Name
Email Address
Social Security Number

Confirm Social Security Number
Date of Birth
Gender
Are you Hispanic or Latino?
Racial Background

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander
I am a (Check one)
By checking this box, you are allowing the college to send an SMS text message to you about important events at the college. Please make sure you keep your current phone information on file.

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Home Address
Country
Home Address
Home Address (Apt, Ste)
City
State
Zip Code Zip Code Extension
Province
Postal Code
Alternate Phone Alternate Phone Area Code Alternate Phone Exchange Alternate Phone Number Alternate Phone Extension Ext:
Cell Phone Cell Phone Area Code Cell Phone Exchange Cell Phone Number Cell Phone Extension Ext:
International Phone Number International Phone Number Extension Ext:

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Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone Number Emergency Contact Phone Number Area Code Emergency Contact Phone Number Exchange Emergency US Phone Number Emergency Contact Phone Number Extension Ext:
Relationship to Emergency Contact

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Highest Level of Education
Program of Interest
HJC Start Date
Are you a US Military Veteran? (Optional)
Are you interested in Financial Aid support?

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Today's Date (mm/dd/yyyy)
Signature (Please type your full name)
How did you hear about HJC?
Are you a former HJC student?
By checking this box, I acknowledge that Degrees within this program require adhering to HJC's drug testing policy.

Yes
Are you disabled?
Purpose of Disclosure: I am seeking to enroll into an Associate Degree program at Huntington Junior College. In order to be granted enrollment, I must verify my prior educational information. Select all that apply:

Provide proof of my completion of a High School Equivalency exam (GED, TASC, or HiSET).

Provide proof of my high school graduation.

Request a transfer of my college transcripts to HJC for transfer credits.
Are you 18 or older?

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