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Items in bold type are required. |
Full Legal Name |
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Last Name |
First Name |
Middle Initial |
Suffix |
Maiden Name |
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(Please provide full legal name-for identification purposes only.)
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Preferred/ Chosen Name (NOT A NICKNAME) |
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Preferred/Chosen First Name |
Mailing Address |
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Street Address |
City |
State/Province |
Zip Code |
County |
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Country |
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Phone
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Cell Phone |
Home Phone |
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Social Security Number
(Format: 999999999)
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Gender |
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Date of Birth
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Ethnic Hispanic/Latino |
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Race (choose one or more) |
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You may be eligible for additional services, please check those that apply.
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Email Address |
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(Please enter your personal email address, not a high school email address.)
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Start Term
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Program of Study
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Campus Location
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Citizenship
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Language |
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Marital Status |
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Residency
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Are you or have you ever been a member of the U.S. Military?
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Are you the spouse/dependent of a U.S. Veteran?
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Emergency Contact Person |
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Emergency Contact Phone Number
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Last High School Attended |
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City
State
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Graduated from High School?
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Years of High School Attendance
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Transfer Information: If you have attended another college or university, complete the
information below and have all official college transcripts sent directly to the Registrar's Office, Alpena Community College,
665 Johnson Street, Alpena, MI 49707-1495.
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College
Degree
Years Attended
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College
Degree
Years Attended
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The information on this application is accurate. I understand that providing false information could
lead to disciplinary action. |
Alpena Community College Institutional Statement of Non-discrimination
For any publication that is related to any activity, service or program that utilizes federal funds:
Alpena Community College policies and practices for admission, employment and activities comply with requirements of
Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendment of 1972 as amended, Section 504 of the
Rehabilitation Act of 1973 as amended, the Age Discrimination in Employment Act of 1967 (ADEA), the Americans with
Disability Act (ADA) of 1990, the ADA Amendments Act of 2010, Title II of the Genetic Information Nondiscrimination
Act of 2008. The College does not discriminate on the basis of race, color, religion, national origin, gender, sex,
age, or disability. The College practices and policies also comply with the Michigan Persons with Disabilities Civil
Rights Act (PDCRA) and the Michigan Elliott-Larson Civil Rights Act (ELCRA) which prohibits discrimination in hiring
based on age, height, weight and marital status and familial status in addition to race, color, religion, sex
(which includes pregnancy) and national origin. For more information, contact the Title IX, Section 504, the Age
Discrimination Act and the Title II coordinator:
Carolyn Daoust, Title IX Coordinator/Director of Human Resources
Office: ACC, Room VLH102
Phone: (989) 358-7211
Email: daoustc@alpenacc.edu
Alpena Community College publishes an Annual Security Report and Annual Fire Safety Report to comply with the
Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act, as amended. In compliance with federal law,
the College notifies all prospective students and employees of how to locate this information. The full text of this
report can be located on the ACC website at: ACC Annual Security Report (PDF)
Paper copies of the report can be obtained at Van Lare Hall Room 110 or by calling (989)358-7235. |
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