Online Application

The first step to becoming a JC student is to complete and submit an online application. Please enter your information in each of the following sections. Fields with a red asterisk (*) are required and must be completed before you can submit your application. Please note that additional questions may become required based on your answers to a previous question.

Student Record

Have you previously applied?

If any of the following are true, please answer this question YES to prevent creating a duplicate in the system. Are you a returning student? Were you enrolled while attending high school? Have you attended JC as a Guest student? Have you attended Kid's College or a similar event?

No

Name Information
Legal First Name* Tristan Legal Middle Name Joseph Legal Last Name* Swartout Suffix Former Name Birth Date*
(mm/dd/yyyy)

Please list only your former last name in this box. Examples of former last names include maiden names as well as those from previous marriages.

10/1/1995 Legal Gender* Male Are you serving/have you served in the Military?
Please provide a copy of your DD-214 for potential transfer credit evaluation.

No Eligible for Military educational benefits? No Spouse/child of a Service Member/Veteran? No

Address & Phone Information

JC is FERPA compliant and only releases information to authorized institutions. To not have your directory information released go to www.jccmi.edu/norelease.

Email Address*

tristanswartout@hotmail.com Check if address is outside of U.S. or Canada No Mailing Address* 6920 Springbrook Rd PO Box City* Horton State/Province Michigan Zip/Postal Code 49246 Message Phone
Message Phone number is a number that JC may leave messages(voicemail, text messages and/or verbal messages with any person who answers at this number) with specific information related to JC (course enrollment, appointments, advising, financial aid, payments, admission, etc.). Format: 1234567890 (no dashes)

5179173374 Primary Phone*

Format: 1234567890 (no dashes)

1-517-529-9815 Secondary Phone

Format: 1234567890 (no dashes)

Citizenship Information

Is English your native language* Yes Native Language

If your native language is not listed, please choose Other form the list.

Are you a US Citizen? Yes Birth Country United States

Optional Ethnic Information

This section is voluntary. Demographic information is reported to the U.S. Office for Civil Rights under Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972. It is not used in admissions decisions, and will not be used in a discriminatory way for participation in, access to, or benefits of programs or services of the College.

Ethnicity
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

American Indian or Alaska Native No Asian No Black or African American

No Native Hawaiian or Other Pacific Islander No White Yes

Optional Disability Information

No

Do you have a documented disability that requires accomodations?

For example workstation modification or a sign language interpreter.

Please enter your information in each of the following sections. Fields with a red asterisk (*) are required and must be completed before you can submit your application. Additional questions may become required based on your answers to a previous question.

Attendance Dates & Course Load

When do you plan to start college?* 2014 Fall (Aug. - Dec.) Expected Enrollment per Semester* Full Time (12 or more credits)

Educational Program

What is your program of study?* General Transfer - Certificate What is your primary reason for attending Transfer (to another college/university after JCC)

Campus Plans & Request for Information

Do you plan to apply for Financial Aid? Yes Are you interested in campus housing? No Do you plan to apply for an honors program?
Phi Theta Kappa (PTK)

No Please enter your information in each of the following sections. Fields with a red asterisk (*) are required and must be completed before you can submit your application. Additional questions may become required based on your answers to a previous question.

High School or Home School Information

To find your high school 1. Select the country in which the school is located 2. If the school is in the United States or Canada, select the State/Province in which the school is located.

3. Type the City name 4. Click Search 5. Choose the School from the Results drop down list 6. Click Select

If you attended a Career Center, Vocational Education Center, or Technology Center please list this as a secondary school.

When using the city search, please note that all words are spelled out except if the city starts with Saint as in these two examples St Louis and Sault Saint Marie.

Career / Technology Center

Have you attended one of the following career/technology centers? (check all that apply)

Hillsdale Workforce Development and Technology Center (HWDTC) No Jackson Area Career Center (JACC) No LISD TECH Center (LISD) No

High School Graduation

Did or will you graduate high school? Yes Which did/will you recieve from your high school? High School Diploma

College Credit
Have you attended other colleges? No Are you currently enrolled in college? No
Select Add College to list each college/university at which you have taken courses for credit. Please have an official transcript sent from each institution as soon as possible.

Please enter your information in each of the following sections. Fields with a red asterisk (*) are required and must be completed before you can submit your application. Additional questions may become required based on your answers to a previous question.

Extracurricular Activities & Interests (Optional)

Please list your principal extracurricular, community, volunteer and family activities and hobbies. Include specific events and/or major accomplishments such as musical instrument played, varsity letters earned, etc. Select Add Extracurricular Activity for each separate activity you would like to include on your application.

Extracurricular Activity 1
Name* Academic Honoraries Do you plan to participate in college? Yes

Extracurricular Activity 2

Name* Athletics Do you plan to participate in college? Yes Please enter your information in each of the following sections. Fields with a red asterisk (*) are required and must be completed before you can submit your application. Additional questions may become required based on your answers to a previous question.

Additional Information

What Influenced you to apply? Family/Friend

Certify & Submit

Please affirm the following before you submit your application.

Do you certify the following?*

I understand that once my application has been submitted it may NOT be altered in any way.

Yes Do you certify the following?*

The information I have provided on this application is correct and complete to the best of my knowledge.

Yes
The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work and the information is factually true. Once you type in your name and the date, this will count as your electronic signature.

Signature* Tristan Swartout Signature Date*

(mm/dd/yyyy)

10/29/2013