Post on 01-Aug-2020
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CAR Building | First Floor, Suite 105 | 765 Newman Springs Road | Lincroft, NJ 07738Telephone: (732) 224-2510 | Fax: (732) 224-1969
BRO
OKDALE COMMUNITY COLLEG
E • EDU
CATIONAL OPPORTUNITY FUND
•
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BROOKDALE COMMUNITY COLLEGEEOF ADMISSIONS APPLICATION
I. BIOGRAPHICAL INFORMATION: Please print information clearly.
SOCIAL SECURITY #: _________________________________________ BROOKDALE ID#: ________________________________________
LAST NAME: ________________________________________ FIRST NAME: _______________________________________M.I. ________
ADDRESS: ______________________________________CITY: ______________________________ STATE: ______ ZIP: _______________
TELEPHONE:_____________________________________________ CELL PHONE: ______________________________________________
E-MAIL: ___________________________________________________ DATE OF BIRTH: ________/________/________ (MM/DD/YYYY)
II. DEMOGRAPHIC INFORMATION
I IDENTIFY MY GENDER AS: _________________________________________________________________________________________
MARITAL STATUS: __________ SINGLE __________ MARRIED __________SEPARATED__________ WIDOWED__________DIVORCED
RACE/ETHNICITY, PLEASE SELF-IDENTIFY: ______________________________________________________________________________
CITIZENSHIP AND RESIDENCY STATUS: _____________________ U.S CITIZEN_____________________PERMANENT RESIDENT
IF PERMANENT RESIDENT, PROVIDE ALIEN REGISTRATION # _______________________________________________________________
HAVE YOU LIVED IN NEW JERSEY FOR A MINIMUM OF 12 CONSECUTIVE MONTHS? ____ YES _____ NO
ARE YOU AN UNDOCUMENTED NJ DREAMER (DACA) ____ YES _____ NO
ENROLLMENT STATUS: Check one of the following to note your entrance status.
o First-Time College Student – High School Senior/Graduate
o First-Time College Student – Recipient of GED/High School Equivalency Diploma
o EOF Transfer Student- Enrolled in an EOF program at another college/university
o Transfer Student – Never enrolled in EOF/EOP program at another college/university
o Current Brookdale Student – Never enrolled in EOF/EOP program at another college/university
PLEASE PROVIDE FULL NAME, AGE, AND RELATIONSHIP TO YOU FOR EACH HOUSEHOLD MEMBER BELOW:
FIRST NAME LAST NAME AGE RELATIONSHIP TO APPLICANT
PERSONAL STATEMENTNOTE: Complete the personal statement only if:
a) your current high school GPA/average is below 2.30/77/C+ (based on a 4.00 scale)
b) your current college/university GPA is below 2.50
c) you earned a GED/High School Equivalency Diploma. Please answer in essay form (minimum: 250 words). You may elect to attach a typewritten statement.
ESSAY: Everyone has a life story. What are some aspects of yours, and how have your personal experiences influenced your academic and career goals?
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ENROLLMENT TERM: ¨FALL 2020 ¨ SPRING 2021