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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:
The 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, 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 and 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 Title II coordinator:
Melissa Guy, Title IX Coordinator/Director of Human Resources, VLH 102, 989.358.7211, email: guym@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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