Community College of Philadelphia - Online Admissions Application

Indicates required fields

Select the semester and year you would like to begin classes at Community College of Philadelphia
Semester: Year:
I intend to enroll for this semester only. Or I intend to continue at the College after this semester.

First Name:

Middle Name:

Last Name:

Former or Maiden, if any:

Social Security No:

E-Mail Address:

Telephone (Day):

Extension:

Telephone (Evening):

Extension:

()

Address:

Address (Line 1):

Address (Line 2):

City:

State:

Zip Code:

How did you learn about Community College of Philadelphia?

Assessment, registration and advising are available in many locations.
Please click the location that is best for you:

	Main Campus		Northwest Regional Center		Northeast Regional Center		West Regional Center
	1700 Spring Garden Street		1300 W. Godfrey Avenue		12901 Townsend Road		4725 Chestnut Street

I would like to attend classes

When would be the best time for you to take your college placement test?
(selected time will be given when possible)
The College offers computerized placement testing (Main Campus and Northwest Regional Center only). Would you prefer to take your placement test on a computer?
Yes No

The most recent high school that I attended:

(mm/yyyy)
Last college, vocational and/or trade school you have attended:	City/State:

Dates Attended: (mm/yyyy) Through (mm/yyyy)
Select the highest college degree earned:

Are you a Veteran? Yes No

Are you a United States Citizen? Yes No If yes, how long? Year(s) Month(s)
If no, what is your visa status? If, "Other" please specify:

Are you a resident of Pennsylvania? Yes No   If yes, how long? Year(s) Month(s)
Are you a resident of Philadelphia? Yes No   If yes, how long? Year(s) Month(s)
Is English your primary (or best) language? Yes No   If no, what is your best language?
   Do you plan to take courses in English as a Second Language?  Yes No

Please select your primary area of interest. If you choose undecided you will be placed in the Liberal Arts Program.

After choosing a primary area of interest you must now choose a program within that interest.

Programs with asterisks (*) are select programs. Admission requires that potential students fulfill special requirements for entry to the program.

The following information is being requested on a voluntary basis for statistical purposes only. It will be kept confidential. Failure to provide it will not affect your admission to the college.

Sex	Date of Birth	Race/Ethnic Background
MF	(mm/dd/yyyy)

Have you successfully completed a college-level English composition and/or college-level Math course with grade of C or better? (Transcripts required.) Yes No
If yes, please list the college and the corresponding courses:

List your ACT Assessment or SAT test scores: (Send Official Score Report)
Verbal Math Date of Test (mm/dd/yyyy)

Have you recently been a student at another college AND do you plan to transfer your COLLEGE courses BACK to that college? Yes No
If yes, have you had a transcript from your other school sent to Community College of Philadelphia? Yes No

Are you enrolling in the Senior Citizen Program? Yes No
If yes, will you be taking courses ONLY on an audit basis? (This means you will NOT receive academic credit for the course.) Yes No

The Community College of Philadelphia offers students to opportunity to pursue tax relief through The Hope Tax Credit and Lifetime Learning Tax Credit. In order for the College to provide you with a report to include with your tax return, please provide the name, address and social security number of the individual who will file the allowable tax deduction. (Note to students: if a parent or guardian claims you as a dependent, you should supply that person's name, address and social security number.) (Click here to copy the applicant's information.)

Hope Tax Credit and Lifetime Learning Tax Credit information.

Social Security Number:

Name: First Middle Last

Address:

City/State/Zip:

For special services because of a physical or a learning disability, call the Center on Disability (215) 751-8050.

There is a one time, non-refundable $20.00 admissions application fee. You can send us a check with a copy of your confirmation page.

By submitting this form, I affirm that all the information given by me in this application is true to the best of my knowledge. I understand that falsification of information is perjury and may be grounds for dismissal. I further affirm that all claims regarding my legal residence and status are correct and honestly presented. I have no intention to willfully defraud the College or its sponsoring agencies.

Affirmative Action Policy Community College of Philadelphia does not discriminate on the grounds of race, color, national origin, religion, gender, age, disability, sexual preference, or status as a disabled veteran or veteran of the Vietnam Era in the administration of any of its educational programs, activities, or employment in accordance with application Federal statutes and regulations.