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SC emearsor: * eee okt eRe tte ae PLEASE TYPE OR POINT IN INK |” rors SECURITY NUMBER [Tel [A] You must SLL your Sociel Security Number from your tocel i Sociel Security Office before submitting this application. ; [2] NAME (PRINT full logs) name) 7 aha C ; Lest , —- ‘ Fint tomo. Cosy > Vc} d that are different BIRTMOATE {ues nymera} MAILING wee eo€ maak sf 1 = Stare PERMANENT ADDRESS. Thos rs the address that you contider to be your permanent revdence. Street oF road name-rmust be m- : _ Ctuded even though you moy Neve aP.O. Box Number. : oO 5 OQ €.DOC} Number and Street | TMENTO Coa FASS : Cuy County State Zip Code " C) TELEPHONE NUMBERS ome AAD =F) hana —_—_ van number of ALL college units compl ered: ; ; am 6. Prone = 2. eee 17K: OK 4, eee 4) - SOK a 1-52 3 30-aH 5. 60-120 : bul no degres : It you Nave # degree check one: A Associate : 8 Seccal surente : uM Masters ad Doctorate | alte tS tlie es Snell, Liane mma ii ele! called oc. ae yah + TERRE ih — tat eee. OMe APPLICATION FOR ADMISSION’ O AMERICAN RIVER COLLEGE LOS RIOS COMMUNITY COLLEOR OSTAiICT A700 Cottege Cet Or., Secramerin, Cs, 9584) DO PLACERVILLE CENTER OFFICE USE ONLY OFFICE USE ONLY O COSUMNES RIVER COLI.EGE 8401 Contes Parkway. Sacrarierty, Ca. 95823 SACRAMENTO CITY COLLEGE * 3035 Freavart Givd., Sacramento, 64 DIATZ [12 Specify the remaster and year for which you are apniying Spring ~ LO Sumner 19 ee — el” MAJOR: See reverse side Wales Lest Attended: 1 a Fail 9 State Did you q:aduste? Cc] vn No meroed G&G. alierded STUDENT CLASSIFICATION (Check one) COMPLETE APPROPRIATE BOXES GELOW — INCL UCE LOS RIOS COLLEGES Lest off colleges. universities and summer sexsons you have atlendedin hronclagcat oruee If, efter filing this applicstion, you undertake courte work in another college oo unwersity, you rust nobty the Admissions Office INCL VOE LOS AIOS COLLEGES. New Student—You will be ettending cottege a tot the frat tiene. New Trantter ~ You fave sitended another college; nts will be the first semester st thls jastitution, ee 3. i Raturning Transfer — Yow arn saturning stter an sbaence end hava altended another col- thes | 10, ie tege since leaving this nstitution 4. i Returning — You are retuming after an ab- sence and you did not attend another cotlege tince leaving. —_—_— 6... Accelerated Student—VYou will be attending Both High School snd coltege. DATES OF ATTENDANCE SCHOOL FRO TO city STATE You mutt request the transcespts of the shove wok to be rent to the Ader scion’ s directly trom each of the cottages lister. MARITAL STATUS RESIDENCY —_ = Please answer the following four questions as of the start of the semester for which you are applying: ‘. Single A. Have you been a citizen of the United States «+ 8 wn XX no No.___ mone No IF YOU ANSWEREO NO TO ONE OR MORE OF THE ABOVE FOUR QUESTIONS, for at least one year? . . Have you lived in California for at feast the - last year? Are you 19 years of age or older? Oo you consider yoursetf a tegal resident of California? 2. = Merried [1] DIVISION XA om . oon ese on Evening CERTIFICATION: t certify the information on this farm is correct and | understand that (aisification of information, omission, or fellure ta report changes in fidence mey result in my immediate dismissal. we