Special Student Status Application

This application begins the process of becoming a special status student which will allow you to enroll in a block or two at the college.

Student Information

First Name *

Middle Name

Last Name *

Preferred Name *

Student Contact Information

Email Address *

Mobile Phone Number

May we send text messages to this number? *

Yes

No

Mailing Address *

Country

Street

City

Region

Postal Code

Student Application Information

HIDDEN: Student Type *

In which semester are you interested in starting? *

In which block are you interested in starting? *

In which course title(s) are you interested?

What are your primary goals in enrolling in this course(s)?

HIDDEN: Round

HIDDEN: sys:app:round_update

Yes

No

Student Educational Information

Current School Name *

HIDDEN: Current School CEEB Code

Please check one *

MAT Candidate

Continuing Education

Current Employee

Spouse/Dependent

Upload your most recent academic transcript

Biographical Information

Birthdate *

Are you a citizen of the United States? *

Please Select Your Citizenship *

Sex assigned at birth *

Female

Male

If you would like the opportunity, we invite you to share more about your gender identity

Are you Hispanic or Latino?

Yes

No

In addition, you may select one or more of the following races

Emergency Contact Information

Family Member 1 Role

First Name

Last Name

Street Address

Country

Street

City

Region

Postal Code

E-Mail Address

Phone

During the academic year, special status students will be charged tuition on a per-block basis which is 1/6 of annual tuition. Generally, scholarship support is not available other than through tuition remission.

I understand that tuition will be charged on a per-block basis *

During the academic year, special status students are not eligible for on-campus housing. You will be expected to find other arrangements near campus.

I understand that on-campus housing will not be available and will make other arrangements *