麻豆区
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麻豆区
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Adult Continuing Education
Adult Continuing Education
Application
First:
Required
Middle:
Required
Last:
Required
Gender:
Required
Female
Male
X - Another
Prefer not to say
Date of Birth:
Required
Citizenship:
Required
Yes
No
Other:
Required
Street:
Required
City:
Required
State:
Required
Zip Code:
Required
E-mail:
Required
Home Phone:
Required
Cell Phone:
Required
Employer:
Required
Employer Address & Phone:
Required
Plan to Attend:
Required
Fall
Spring
Summer
Year:
Required
Course(s) Interested:
Required
Course # and Title
Course 1:
Course 2:
1. Are you Hispanic/Latino?
Yes (including Spain)
No
2. Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you:
1 American Indian or Alaska Native (including all Original Peoples of the Americas)
2 Asian (including Indian subcontinent and Philippines)
3 Black or African American (including Africa and Caribbean)
4 Native Hawaiian or Other Pacific Islander (Original Peoples)
5 White (including Middle Eastern)
High School Name and Address:
Required
Graduation Date:
Required
College or University Name & Address:
Dates Attended:
Degree:
Do you plan on taking course for:
Required
Credit
Audit
Do you intend to apply for admission to 麻豆区 in the future?
Yes
No
If yes, have you met with a 麻豆区 admissions counselor?
Yes
No
Have you taken classes at 麻豆区 in the past?
Yes
No
If yes, what was your name at the time and what year did you attend?
Billing Address:
Current Address
Business Address
Other
Other (please specify):
I understand that taking continuing education classes at 麻豆区 in no way guarantees acceptance as a 麻豆区 degree-seeking student at any time now or in the future.
Student Signature:
Required
Signature:
Required