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Admissions Application

The document provides contact and website information for 7 colleges that are part of the Dallas County Community College District (DCCCD), including addresses, phone numbers, and URLs. It also includes instructions and forms for applying to the DCCCD colleges, noting requirements for Texas residency classification and guidelines for completing different sections of the application based on residency status and prior college attendance. The application requests biographical information and educational history and provides information about Texas Success Initiative (TSI) assessment requirements.

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rkdus
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
85 views13 pages

Admissions Application

The document provides contact and website information for 7 colleges that are part of the Dallas County Community College District (DCCCD), including addresses, phone numbers, and URLs. It also includes instructions and forms for applying to the DCCCD colleges, noting requirements for Texas residency classification and guidelines for completing different sections of the application based on residency status and prior college attendance. The application requests biographical information and educational history and provides information about Texas Success Initiative (TSI) assessment requirements.

Uploaded by

rkdus
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Brookhaven College

3939 Valley View Lane


Farmers Branch, TX 75244
972-860-4883
www.bhc.dcccd.edu/

Cedar Valley College


3030 North Dallas Avenue
Lancaster, TX 75134
972-860-8201
www.cvc.dcccd.edu/

Eastfield College
3737 Motley Drive
Mesquite, TX 75150
972-860-7167
www.efc.dcccd.edu/

El Centro College/BPI
801 Main Street
Dallas, TX 75202
214-860-2000
www.ecc.dcccd.edu/

Mountain View College


4849 W. Illinois Avenue
Dallas, TX 75211
214-860-8600
www.mvc.dcccd.edu/

North Lake College


5001 N. MacArthur Blvd.
Irving, TX 75038
972-273-3183
www.nlc.dcccd.edu/

Richland College
12800 Abrams Road
Dallas, TX 75243
972-238-6100
www.rlc.dcccd.edu/

Admissions
Application
for the
Colleges of the Dallas County Community College District

Educational opportunities are offered by the Dallas County Community College District without regard to race,
color, religion, gender, national origin, disability, sexual orientation, gender identity, gender expression, or any
other basis prohibited by law.

FORM NO. 0664-09/14

DCCCD Home Page URL: http://www.dcccd.edu

INSTRUCTIONS
1. All applicants must complete Part A and Part I.
2. Applicants wishing to claim Texas residence for tuition purposes must complete the
following:

Students of a Texas public college or university during the past 12 months, who paid
resident (in-state) tuition, without a tuition waiver, must complete Part A, B and I.

Recent high school graduates must complete Part A, B, C, D and I.

Dependents of Texas residents must complete Part A, B, C, D, E, G and I.

Applicants who did not attend a Texas public college or university during the past 12
months must complete Part A, B, C, D, E, F and I.

Part H is for any additional information an applicant believes the college should know
in evaluating Texas residence.

3. Applicants who are not claiming Texas residence for tuition purposes must complete Part
A, B, C and I only.
BIOGRAPHICAL INFORMATION
Questions with an asterisk (*) are voluntary, and the information provided will remain confidential.
In addition, supplying your social security number, gender, and ethnicity enables a more expedient
match of test scores, transcripts, financial aid benefits, and tuition refunds.
APPLICATION METHODS
Applicants may apply one of three ways:
1. An online application process is available for credit students at http://econnect.dcccd.edu.
2. Apply Texas Online Application www.ApplyTexas.org
3. An Adobe PDF version of the application is available to download and complete. Needs to be
submitted to the college Admissions office.
h t t p : / / www.dcccd.ed u/ wh y/ appl y/ adm i s s i on/ pages / defaul t .as p x

Please print in blue or black ink and complete all appropriate Parts.
The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to
their education records. If you wish to protect your directory information from disclosure, proceed to
the following website or contact the Admissions/Registrars Office.

FORM NO. 0664-09/14

DCCCD Home Page URL: http://www.dcccd.edu

Student Name:

Student ID Number:

COLLEGE YOU PLAN TO ATTEND

Brookhaven

Cedar Valley

Mountain View

North Lake

SEMESTER YOU PLAN TO ATTEND

Eastfield

El Centro

Fall (Aug-Dec)
Winter Term (Dec/Jan)

Richland

Spring (JanMay)
May Term (May)
Summer (JunAug)

Colleges of the Dallas County Community College District


Students who apply to one of the colleges listed above are eligible to
attend any of the colleges that are listed.

FOR OFFICE USE


Date Received:

Admissions Application
Your responses to questions with an asterisk (*) are voluntary.

Part A: Biographical Information


Residency Code:

Your Social Security Number or tax identification number is required. Your number will remain confidential.

E-Mail Address:

Supplying your Social Security Number enables a more expedient match of your test scores, transcripts & financial aid benefits.
Choose One

(This is our primary means of communication.)

The following is my Social Security Number or tax identification number:

NAME

County Code:

I do not have a Social Security Number or tax identification number.

*GENDER

Give full legal name. Do not use initials unless initials are your legal name.

F
Last

First

Middle

Give names, if different from above, that are on transcripts from other institutions.

Current Street Address (must be a physical address)

City

State

How Admitted:

DATE OF BIRTH (MM/DD/YY)

Apartment

Zip

Term:

Do you live in Dallas County?


YES
NO

Citizen:

Permanent Mailing Address (can be a PO Box number)


TSI Status:
Home Number (Include Area Code)

Work Number (Include Area Code)

Cell Number (Include Area Code)


Cond. Agreement:

PERSON TO NOTIFY IN THE EVENT OF AN EMERGENCY


Name ____________________________________________________________

Phone Number ( ________ ) ______________________________

Rising Star:

* Ethnicity and Racial Background: (How do you identify yourself?) This information will be used for federal
and/or state law reporting purposes only.
Tech Prep:

Are you Hispanic or Latino? _________ Yes _________ No

_________ unknown or I choose not to respond.

Please select the racial category or categories with which you most closely identify. Check as many as apply.
___ White (1)
___ Native American/Alaskan (5)

___ Black or African American (2)


___ Unknown/No response (7)

Dual Credit:

___ Asian (4)


___ Native Hawaiian or Pacific Islander (8)

My Primary Language is: _____________________________________________

Staff:

Place of Birth: ___________________________________ State: _________________ Country: ______________________

REASON FOR ATTENDING

I will take courses:

To Earn a One-Year Certificate (APPN.CERT)

To Earn a Two-Year Degree (APPN.ASSOCIATE)

To Improve Job Skills (APPN. J/R)

To Transfer to a University (APPN.U/T)

For Personal Interest (APPN.N/D)

Uncertain (APPN.UNCERTAIN)

Military-Veteran Status If you have any military affiliations, please indicate by selecting all that apply:
Current/Former member of the US Armed Forces

Dependent of a veteran

Current/Former member of the National Guard

Dependent of a deceased veteran

Current/Former member of the Reserves

Dependent of a veteran with a combat-related injury

FORM NO. 0664-09/14

-1-

Admissions Application

Student Name:

Student ID Number:

1. Are you a U.S. Citizen?


YES
NO
If no, of what country are you a citizen? ___________________________________________
2. If you are not a citizen, do you hold Permanent Resident status (valid I-551) for the U.S.?
YES
NO
(If Yes, date permanent resident card issued:_______/_______/_____.) Enclose a copy of both sides of the card.
(Month) (Day) (Year)
3. If you are not a U.S. citizen or permanent resident, do you have an Application to Register Permanent Residence
(form I-485) pending with the U.S. Citizenship and Immigration Services (USCIS)?
YES
NO
(If Yes, enclose a copy of your Notice of Action from the USCIS, form I-797C.)
4. If you are not a citizen or permanent resident and have no application pending with the USCIS, have you lived or will you have in Texas
for at least 36 consecutive months immediately before graduating from high school or receiving a GED in Texas?
YES
NO
(If Yes, please submit a completed Affidavit of Intent to Become a Permanent Resident)

Educational Data
Name of High School Attended: _________________________________ City: _________________________ State: ______
Graduated/Expected Graduation Date (Month) _________ (Year) _________
Did not graduate from High School
Please answer each question:
Were you home schooled?
Yes
No
Did you take a Career Pathway course or courses for college credit?
Yes
No
Did or will you graduate with an IB diploma?
Yes
No
If you did not graduate from high school do you have a GED?
Yes
No
If yes, completion date (Month) _________ (Year) _________ which version:
In what state did you receive your GED? ______________

English

Spanish

Official transcripts for ALL previous college work MUST be submitted. Failure to list all institutions will be considered an
intentional omission and may result in the denial of future enrollment.

List ALL Colleges attended. Attach separate sheet, if necessary.


Dates attended

Name and Location (City and State)

FROM
TO
(Month/Year) (Month/Year)

(most recent first)

Hours
Credits

Degree Cert.
Received
(if any)

Currently on
Suspension

Yes / No

1.
2.
3.
4.
5.

Texas Success Initiative (TSI)


An institution of higher education shall assess the academic skills of each entering undergraduate student to determine the students readiness to
enroll in Freshman-level academic coursework. Some students may be exempt from meeting the requirement of the TSI; however, students will be
required to meet college course prerequisite requirements. Please read the following and check the appropriate box that applies to you:
I have taken:

STAAR

SAT

ACT

I have not taken one of the tests listed above. I understand that I may have to take a test prior to registration.
I have taken: TSIA or formerly approved TSI assessment (Accuplacer/Asset/Compass/THEA/TAKS)
Exemptions:
1. I am eligible for exemption from additional TSI assessment.
2. I claim an exemption because I am serving on active duty as a member of the U.S. armed forces, the Texas National Guard, or as a member
of a reserve component of the U.S. armed forces and have been serving for at least 3 years preceding enrollment.
Official documentation must be provided to prove exemptions.
3. I claim an exemption because I was honorably discharged, retired, or released from active duty as a member of the U.S. armed forces, the
Texas National Guard, or service as a member of a reserve component of the U.S. armed forces on or after August 1, 1990.
Official documentation must be provided to prove exemptions.

FORM NO. 0664-09/14

-2-

Admissions Application

Student Name:

Student ID Number:

Texas Higher Education Coordinating Board rule 21.731 requires each


student applying to enroll at an institution to respond to a set of core
residency questions for the purpose of determining the students
eligibility for classification as a resident.
Part B: Previous Enrollment
1.

During the 12 months prior to the term for which you are applying, did you attend a public college or
university in Texas in a fall or spring term?
YES

NO

If you answered no, continue on to Part C RESIDENCY CLAIM.


If you answered yes, complete questions 2 thru 5.
2. What Texas public institution did you last attend? (Give full name, not just initials.)

__________________________________________
3. In which term were you last enrolled?

Fall, 20 _____

Spring, 20 _____

4. During your last semester at a Texas public institution, did you pay resident (in-state) or nonresident
(out-of-state) tuition?
resident (in-state)
nonresident (out-of-state)
unknown
5. If you paid in-state tuition at your last Texas public institution, was it because you were a Texas resident
or because you were a nonresident who received a waiver?
resident
nonresident with a waiver
unknown

IMPORTANT: If you were enrolled at a Texas public institution during a fall or spring semester within the
previous 12 months and were classified as a Texas resident,
SKIP TO Part I CERTIFICATION of INFORMATION,
SIGN and DATE THIS APPLICATION and SUBMIT.
If you were not enrolled, or if you were enrolled but classified as a nonresident,
proceed to Part C RESIDENCY CLAIM.

Part C: Residency Claim


1. Are you a resident of Texas?

YES

NO

If you answered yes, continue to Part D ACQUISITION of HIGH SCHOOL DIPLOMA or GED.
If you answered no, complete the following question:
Of what state or country are you a resident? _____________________________
Continue to Part I CERTIFICATION of INFORMATION.
If you are uncertain, continue to Part D ACQUISITION of HIGH SCHOOL DIPLOMA or GED.

FORM NO. 0664-09/14

-3-

Admissions Application

Student Name:

Student ID Number:

Part D: Acquisition of High School Diploma or GED


Yes
1.

No

Did you live in Texas or will you have lived in Texas the 36 consecutive months
leading up to high school graduation or completion of the GED?

(To answer Yes you must have graduated from a Texas public or private high school or earn or plan
to earn a GED. All others, including home-schooled students who do not plan to earn a GED, must
answer No.)

2.

When you begin the semester for which you are applying, will you have lived in
Texas for the previous 12 consecutive months?

Instructions for Part D:


If you answered no to question 1 or 2, go to Part E BASIS OF CLAIM TO RESIDENCY.
If you are a U.S. citizen or permanent resident and you answered yes to questions 1and 2, go to
Part I CERTIFICATION OF INFORMATION.
If you did not graduate from a Texas high school, continue to Part E BASIS OF CLAIM TO RESIDENCY.

Part E: Basis of Claim to Residency


TO BE COMPLETED BY EVERYONE WHO ANSWERED NO TO QUESTIONS 1 or 2
OF Part D or WHO DID NOT GRADUATE FROM A TEXAS HIGH SCHOOL.
1. Do you file your own federal income tax as an independent tax payer?

YES

NO

(Independent tax payer should not be claimed as a dependent for tax purposes by another
person. If you file a joint return with your spouse, answer yes.)
2. Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or
YES
NO
court-appointed legal guardian?
(To be eligible to be claimed as a dependent, your parent or legal guardian must provide more than
one-half of your support. A step-parent does not qualify as a parent if he/she has not adopted the
student.)
3. If you answered No to both questions above, who provides the majority of your support?
Self
Parent or Legal Guardian
Other: (list) ______________________________________
Instructions for Part E:
If you answered yes to question 1, go to Part

F.

If you answered yes to question 2, go to Part

G.

If you answered no to 1 and 2 and self to question 3, go to Part

F.

If you answered no to 1 and 2 and parent or legal guardian to question 3, go to Part G.


If you answered no to 1 and 2 and other to question 3, go to Part

FORM NO. 0664-09/14

-4-

H, provide an explanation and complete Part I.

Admissions Application

Student Name:

Student ID Number:

Part F: Questions for students who answered Yes to Question 1 or Self to Question 3 of Part E
Yes

No

Years

Months

Visa/Status

1. Are you a foreign national who has submitted an application for Permanent
Resident Status to the U.S. Citizenship and Immigration Service (USCIS) and
has received a fee/filing receipt or notice action (I-797) from USCIS showing
that your I-485 has gone through preliminary review and not been rejected?
Visa/Status

2. Are you a foreign national here with a visa eligible to domicile in the United
States or are you a Refugee, Asylee, Parolee, or here under Temporary
Protective Status?
If so, indicate which.
3. Do you currently live in Texas?
If you are out of state due to a temporary assignment or for another reason,
please answer NO & explain in Part H.
Years

4a. If you currently live in Texas, how long have you been living here?
b. What is your main reason for being in the state?
If for reasons other than those listed, give an explanation in Part H.

Months

Attend College
Work Assignment
Establish and Maintain a Home
Yes

No

5. If you are a member of the U.S. military, is Texas your Home of Record?
STATE

What state is listed as your military legal residence for tax purposes on your
Leave and Earnings Statement?
6. Do any of the following apply to you: (Check all that apply.)

Yes

No

Yes

No

Yes

No

Yes

No

a. Do you hold the title (warranty deed, deed of trust, or other similar instrument
that is effective to hold title) to residential real property in Texas?
If yes, date acquired: ______________________________________
b. Do you have ownership interest and customarily manage a business in
Texas without the intention of liquidation in the foreseeable future?
If yes, date acquired: ______________________________________
7a.

For the past twelve months have you been gainfully employed in Texas?
(Gainful employment requires an average employment of at least twenty hours per
week for one year or earnings equal to at least half of tuition and living expenses for one
nine month academic year. Employment conditioned on student status such as work
study, receipt of stipends, fellowships or research or teaching assistantships does not
constitute gainful employment.)

b. For the past twelve months, have you received primary support from a
social service agency?
8a. Are you married to a person who could answer yes to any part of
questions 6 or 7?
b. If yes, indicate which question could be answered yes by your spouse.
Question: ____________________
c. How long have you been married to the Texas resident?
Years

Months

IF YOU COMPLETED Part F, SKIP Part G and CONTINUE TO Part H.


FORM NO. 0664-09/14

-5-

Admissions Application

Student Name:

Student ID Number:

Part G: Questions for students who answered Parent or Legal Guardian to Question 3 of Part E
Yes

No

Years

Months

Visa/Status

1. Is the parent or legal guardian upon whom you base your claim of
residency a U.S. Citizen?
2. Is the parent or legal guardian upon whom you base your claim of
residency a Permanent Resident?
3. Is this parent or legal guardian a foreign national whose application for
Permanent Resident Status has been preliminarily reviewed?
(He or she should have received a fee/filing receipt or Notice of
Action [I-797C] from the USCIS showing his or her I-485 has been
reviewed and has not been rejected.)
4. Is this parent or legal guardian a foreign national here with a visa or is a
Refugee, Asylee, Parolee, or here under Temporary Protective Status?
If so, indicate which.
5. Does this parent or legal guardian currently live in Texas?
(If your parent or legal guardian is out of state due to a temporary job
assignment or for another reason, please explain in Part H.)

Visa/Status

Yes

No

Years

6a. If your parent or legal guardian is currently living in Texas, how long has
he or she been living here?
b. What is your parents or legal guardians main reason for being in the state?
If for reasons other than those listed, give an explanation in Part H.

Months

Attend College
Work Assignment
Establish and Maintain a Home
Yes

No

7. If your parent or legal guardian is a member of the U. S. military, is Texas


his/her Home of Record?
What state is listed as your parents or legal guardians residence for tax
purposes on his or her Leave and Earnings Statement?
8a. Does your parent or legal guardian hold the title (warranty deed, deed of
trust, or other similar instrument that is effective to hold title) to residential
real property in Texas?
If yes, date acquired: ___________________________________

STATE

Yes

No

Yes

No

Yes

No

b. Does your parent or legal guardian have ownership interest and customarily
manage a business in Texas without the intention of liquidation in the
foreseeable future?
If yes, date acquired: ___________________________________
9. For the past twelve months has your parent or legal guardian:
a. Been gainfully employed in Texas?
(Gainful employment requires an average employment of at least twenty hours per
week for one year or earnings equal to at least half of tuition and living expenses for one
nine month academic year. Employment conditioned on student status such as work
study, the receipt of stipends, fellowships or research or teaching assistantships does not
constitute gainful employment.)

b.
10 a.

Received primary support from a social service agency?


Is your parent or legal guardian married to a person who could answer
yes to any part of question 8 or 9?

b.

If yes, indicate which question could be answered yes by his or


her spouse.
Question: ____________________

c.

How long has your parent or legal guardian been married to the Texas
resident?

FORM NO. 0664-09/14

-6-

Years

Months
Admissions Application

Student Name:

Student ID Number:

Part H: General Comments


Provide any additional information that you believe your college should know about evaluating your eligibility to be
classified as a resident? If so, please provide it below.

Part I: Residency and Meningitis Information

All students must complete this section.

Who: Students must provide proof of meningitis vaccination if:


You are enrolling for the first time as a credit student.
You are returning after a semester break in enrollment.
You are transferring from another college or university.
You are a new or returning continuing education student enrolled in programs with 360 contact hours or more.
You are a dual credit, Middle College, Early College or charter high school student attending classes on the college campus.
You are a continuing education student who is enrolled in concurrent credit courses.
Deadline: You must submit proof of vaccination (or booster shot within the last five years) to your colleges Admissions/Registrars Office before
registering for class. The date of the vaccination must be at least 10 days before the first day of class. This allows time for the vaccination to take
effect.
Where: Take proof of bacterial meningitis vaccination to the Admissions/Registrars Office to the college where you are enrolled.
Exceptions to the new law: You do not need to provide proof of meningitis vaccination under several exceptions:
You are 22 years of age or older (by the first day of the semester in which you are enrolled).
You are enrolled 100 percent in distance education classes. You must complete the 100 percent distance education affidavit and
fax or email it to your college. Form found at https://www1.dcccd.edu/catalog/admiss/bacterial.cfm?loc=econ
under Exceptions item #2 at https://www1.dcccd.edu/catalog/admiss/Bac_Men_100_DLAffidavit_Jan2014.pdf
You are enrolled in a continuing education course or program that is less than 360 contact hours or in continuing education corporate
training.
You are enrolled in one or more dual credit courses taught at a public or private K-12 facility which is not located on a college campus.
You are a student who is incarcerated in a prison located in the state of Texas.
Exemptions: A student or the students parents or guardians are not required to submit evidence of the bacterial meningitis vaccination if the
student, parent or guardian submits one of the following affidavits, based on health and well-being or for reasons of conscience, including
religious beliefs. For either of these exemptions, you must submit to the Admissions/Registrars Office:
The Bacterial Meningitis Vaccination Exemption Form, which can be found at http://www.thecb.state.tx.us/reports/PDF/2602.PDF
and one of the following:
An affidavit or certificate signed by a physician who is duly registered and licensed to practice medicine in the United States in which it is stated,
in the doctors opinion, that the vaccination would injure the health and wellbeing of the student; or
An affidavit signed by the student stating that the student declines the vaccination for reasons of conscience, including a religious belief.
A conscientious exemption form from the Texas Higher Education Coordinating Board (THECB)
http://www.thecb.state.tx.us/reports/PDF/2602.PDF for students who are 18 years of age or older, or the Texas Department of State Health
Services (DSHS) https://webds.dshs.state.tx.us/immco/default.aspx for students who are 17 years of age or younger must be used.
Students may obtain bacterial meningitis vaccinations from their own physicians, local health departments, clinics, area drug stores and similar
facilities. For more information about bacterial meningitis, visit the Centers for Disease Control at http://www.cdc.gov/meningitis/index.html.

Certificate of Understanding
I understand that officials of my college/university will use the information submitted on this form to determine my status for residency eligibility.
I authorize the college/university to verify the information I have provided, including my Texas Success Initiative (TSI) test scores and residency
information as necessary. I agree to notify the proper officials of the institution of any changes in the information provided. I certify that the
information in this application is complete and correct, and I understand that the submission of false information is grounds for rejection of my
application, withdrawal of any offer of acceptance, cancellation of enrollment, or appropriate disciplinary action.
I understand that my signature below verifies that I understand and will comply with the Meningitis requirement and Residency Oath stated above.
I will submit all official transcripts from all U.S. accredited institutions previously attended. I also verify that I have received or will receive
information about bacterial meningitis from the college as required by Section 51.9191 of the Texas Education Code.

Signature: _____________________________________

FORM NO. 0664-09/14

-7-

Date: ___________________
Admissions Application

Student Name:

Student ID Number:

The Admissions/Registrars Office reserves the right


to request additional information in order to comply
with state residency requirements prior to enrollment.
Students found to have been incorrectly classified as a resident for tuition purposes
due to information/documentation submitted must begin to pay the nonresident rate
immediately and have a maximum of 30 days to repay all previous terms.
DOCUMENTS SUBMITTED TO MEET ADMISSIONS AND RESIDENCY REQUIREMENTS
BECOME THE PROPERTY OF THE COLLEGE.

The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect
to their education records. If you wish to protect your directory information from disclosure, proceed
to the following website or contact the Admissions/Registrars Office.
For information see: ht t p: / / econnect .dcc cd. edu

Educational opportunities are offered by the Dallas County Community College District without regard to race, color,
religion, gender, national origin, age, disability, sexual orientation, gender identity, gender expression, or any other
basis prohibited by law.

FORM NO. 0664-09/14

-8-

Admissions Application

You must be in the presence of a Notary to complete and sign this Affidavit.
Before you complete this page see PAGE 2 question 4.

AFFIDAVIT OF INTENT TO BECOME A


PERMANENT RESIDENT
STATE OF TEXAS
COUNTY OF __________________

Before me, the undersigned Notary Public, on this day personally appeared
____________________________________________________________________ ,
known to me, who being by me duly sworn upon his/her oath, deposed and said:
1.

My name is _________________________________________________________.
I am _______ years of age and have personal knowledge of the facts stated herein and they
are all true and correct.

2.

I graduated or will graduate from a Texas high school or received my GED certificate in
Texas.

3.

I resided in Texas for 36 months leading up to graduation from high school or receiving my
GED certificate.

4.

I have resided or will have resided in Texas for the 12 months prior to the census date of the
semester in which I will enroll in _______________________________ (college/university).

5.

I have filed or will file an application to become a permanent resident at the earliest
opportunity that I am eligible to do so.

In witness whereof, this __________ day of ____________________________, ___________.


________________________________________
(Signature)
________________________________________
(Printed Name)
__________________|_____________________
(Student I.D. #)
(Date of Birth)
SUBSCRIBED TO AND SWORN TO BEFORE ME, on the ____________________ day of
__________________________________, ______________________, to certify which witness
my hand and official seal.
________________________________________
Notary Public in and for the State of Texas
FORM NO. 0664-09/14

Admissions Application - Affidavit

E-MAIL
How is my e-mail address used? E-mail is the colleges choice means of communication with
students. E-mail addresses, personal or district-provided, are used to notify students of official
pertinent information and information for activities in which the student has expressed interest.
In addition, all students are required to have an e-mail address on file at the
Admissions/Registrars office in order to utilize personalized online services (eConnect) that
require a login and to activate their online account. Having an e-mail address on record allows
students to use personalized services, such as registration, retrieval of grades and financial aid
disbursement information, reset password and receive confirmation of the change via e-mail, and
so forth. If students wish to use eConnect, a valid e-mail address must be on file at the
Admissions/Registrars Office.
What if I dont want to use my personal e-mail address? The college provides currently enrolled
students the ability to request a student e-mail address (NETMAIL) free of charge. Students may
request a NETMAIL e-mail address online through your eConnect account or contact the college
for more information.
Will my e-mail address be released or sold to a third party? E-mail addresses on file in the
Admissions/Registrars Office are considered part of directory information and may be requested
by outside sources under the Public Information Act, but are not sold to outside sources for
profit.
REGISTRATION
How can I register for credit classes? New-to-college students must participate in an orientation
session or see an advisor before registering for credit classes. Students who have attended
college before, who meet eConnect registration eligibility criteria, and who have a valid e-mail
address on file at the Admissions/Registrars Office, may register online through your eConnect
account. All other students may register through the Counseling/Advising office at the college.

PROTECTION OF INFORMATION
Our college privacy commitment is based on two simple ideas. We promise to:

Comply with all the applicable local, state and federal laws and regulations
Protect your privacy while still offering relevant, personalized service

Students may request that their directory information, including e-mail address, be protected to
prevent the release of information to outside sources by submitting a request online to the
Admissions/Registrars Office.
eConnect has carefully combined the very best security software and systems at every level to
ensure that the information entrusted to us is not intercepted or abused. Industry standard
technologies like SSL (Secure Socket Layers) are used to protect credit card numbers, e-mail
addresses and zip codes so they cannot be read as they travel over the Internet.

FORM NO. 0664-09/14

DCCCD Home Page URL: http://www.dcccd.edu

Brookhaven College
3939 Valley View Lane
Farmers Branch, TX 75244
972-860-4883
www.bhc.dcccd.edu/

Cedar Valley College


3030 North Dallas Avenue
Lancaster, TX 75134
972-860-8201
www.cvc.dcccd.edu/

Eastfield College
3737 Motley Drive
Mesquite, TX 75150
972-860-7167
www.efc.dcccd.edu/

El Centro College/BPI
801 Main Street
Dallas, TX 75202
214-860-2000
www.ecc.dcccd.edu/

Mountain View College


4849 W. Illinois Avenue
Dallas, TX 75211
214-860-8600
www.mvc.dcccd.edu/

North Lake College


5001 N. MacArthur Blvd.
Irving, TX 75038
972-273-3183
www.nlc.dcccd.edu/

Richland College
12800 Abrams Road
Dallas, TX 75243
972-238-6100
www.rlc.dcccd.edu/

Dallas Colleges
Online

FORM NO. 0664-09/14

DCCCD Home Page URL: http://www.dcccd.edu

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