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Application for Admission

Application For Admission

1. Apply for: 

2. Date  
3. Social Security Number (No Dashes)
 
4. Legal Name 


 First:   
Middle:
Last:   
5. Former or Maiden Name
 
6. Address (Street or P.O. Box)

City, State and Zip  

   

County  
7. Phone Number(1231231234)
8. E-Mail
 
9. Maine Resident?

If yes, since what date?
10. United States Citizen?

If no, what country?
11. Entering
12. Birthdate (MMDDYYYY)
 

Program and Degree Applying For:







































Other (specify)     
13a. Preferences
13b.  Do you intend to complete your degree online?
 
14. Have you completed the prerequisites for your program?
15. Are you now or have you attended KVCC for credit courses in the past?
16. Have you previously applied for (but not attended) any KVCC day program in the past two years?
If yes, what year and (if applicable) what program?

Under what name?
17. Do you have a relative who attended KVCC?
18. Have you applied for Financial Aid?
If you need Financial Assistance, please call 1-800-528-5882,ext.5121
 
19. Are you planning to have the Veterans Administration help finance your education?
 
20. Enter the highest grade completed in high school:
 
21. Please enter the Month/Year that you graduated or expect to graduate or expect to receive your G.E.D.
 
22. High school last attended. Please include the city/town and state.
23. High School Curriculum:


 
24. If vocational was checked, was it a one or two year program?
Name of Regional or Vocational/Technical Center  
25. Colleges, Universities or Institutes Attended:
Institute:
Credits Earned:
Institute:
Credits Earned:
Institute:
Credits Earned:
 
26. Have you ever taken or do you plan to take the SAT (Scholastic Aptitude Tests) exams?
If yes, please have scores sent to KVCC.
When? (enter month and year)
27. Did your parent(s) or guardian(s) with whom you live or lived with graduate from a four year college?
Highest degree earned.
 
28. What is the main reason you are applying to KVCC? (choose one)




 
29.Is English the primary language you speak at home?
30. Gender:
31. Which of these best describes your background?





 
32.  WORK HISTORY
Current or Most Recent Job Held to Date:
Job Title:
Employer:
Address:
Hours per week:
Dates Employed(month and year): To:
 
Previous Job Held:  
Job Title:
Employer:
Address:
Hours per week:
Dates Employed(month and year): To:
33.  REQUIRED PERSONAL STATEMENT In the space provided, please compose an essay to explain your interest in attending the program you have selected.  Please express your thoughts clearly, especially in relation to your career goals.  Thank you.

 
(Parent or guardian if a minor)     Date:
Signature of Applicant     Date:
 

DIRECTORY EXCLUSION

(STATEMENT OF CONFIDENTIALITY)

The Family Rights and Privacy Act of 1974 is intended to protect students with regard to access and release of their records and personal data. A student's name, class, major and address may be released unless the Directory Exclusion box is checked. If checked, you must be aware, however, that information will be suppressed for all inquiries including family, prospective employers and friends. Disclosure is normally made only to educational personnel and others outlined in the above Act except in emergencies as determined by the College. Click here to have your information excluded.

     I wish to be considered as an applicant for the program. If I am accepted, I agree to abide by the rules and regulations of the school and concede to the school the right to require my withdrawal upon violation thereof. I understand that failure to furnish all information on past education, past employment, military service and personal background may constitute adequate reason for disqualification or subsequent dismissal.
     In consideration of the undertaking by the Admissions Office to process this form, the undersigned agrees that the information furnished on this application for admission, together with all information and materials of any kind, received by the Admissions Office from any source, or prepared by anyone at its request, shall be completely confidential. It shall not be disclosed to anyone, including the candidate and candidate's family; except that the Director of Admissions may, for official purposes, within legal constraints, disclose any part or all thereof to authorized persons.

Kennebec Valley Community College does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities.  Inquiries about the College’s compliance with, and policies that prohibit discrimination on these bases may be directed to: Affirmative Action Officer, John Delile, at 453-5123, Frye Building Room 101, 92 Western Avenue, Fairfield, Maine, 04937, phone (207)453-5123, jdelile@kvcc.me.edu , fax (207)453-5010; United States Department of Education, Office for Civil Rights, 33 Arch Street, Suite 900, Boston, MA  02110, telephone 617.289.0111, TTY/TDD 617.289.0063, fax 617.289.0150, e-mail OCR.Boston@ed.gov, internet http://www.ed.gov/about/offices/list/ocr/index.html?src=oc; Maine Human Rights Commission (MHRC), 51 State House Station, Augusta, ME  04333-0051, telephone 207.624.6050, TTY/TDD 207.624.6064, fax  207.624.6063, internet http://www.state.me.us/mhrc/index.shtml; and/or Equal Employment Opportunity Commission, 475 Government Center, Boston, MA  02203, telephone 617.565.3200 or 1.800.669.4000, TTY 617.565.3204 or 1.800.669.6820, fax 617.565.3196, internet http://www.eeoc.gov/.  The College also does not discriminate on the basis of sexual preference or marital, parental, or veteran’s status.  Inquiries about the College’s policies that prohibit discrimination on these bases may be directed to the Affirmative Action Officer or MHRC identified above.

 
Please make sure all POP-UP BLOCKERS ARE OFF before submitting this application.

 

 

Jim Bourgoin
Director of  Admissions
Our staff is available to discuss your educational interests and our academic programs and student support services.
Admissions Office
Carter Hall Room 220
Monday-Friday
8:00 am-4:30 pm
Ph: (207) 453-5131
      (207) 453-5155
      (800) 528-5882 ext 5131
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