JOINT ADMISSION APPLICATION
COOPERATIVE REGIONAL TOURISM PROGRAM

Please indicate District of Residence (should correspond to your home address):
John A. Logan College
Rend Lake College
Shawnee Community College
Southeastern Illinois College
Other (Please specify) 		 

PERSONAL INFORMATION
Social Security Number:
-
-
Name(Last)
(First)
(Middle)
(Previous)
Address(Street)
(City)
(State)
(Zip)
(County)
E-Mail Address
Phone (
)
          
Birth Date
/
/
(MM/DD/YYYY)
Gender: Male Female
 
Veteran: Yes No
 
Marital Status: Single Married Divorced Widowed Separated
 
Emergency Contact Name:
Phone: (
)

HIGH SCHOOL INFORMATION
High School Last Attended:
Graduation Date:
/
(MM/YY)
Still Attending:
GED Date:
/
(MM/YY)

ETHNIC BACKGROUND (voluntary)
Asian or Pacific Islander American Indian/Alaskan Native Black (non-Hispanic)
Hispanic White (non-Hispanic) Non-resident Alien
 

ENROLLMENT INTENTION
Not planning to transfer Planning to transfer
 
If planning to transfer, where?
Future Job
Improve Job Skills
Personal Interest
GED
Other/Unknown

ENTRANCE TERM
 (Please supply the year of the term you plan to enter the program)
Spring 20
Summer 20
Fall 20

DEGREE (check only one)
Associate in ArtsOther  

ENROLLMENT OBJECTIVE
Complete one or several courses Associate Degree
 

HIGHEST DEGREE EARNED
GED High School Diploma Certificate
Unknown Associate Degree Bachelor's Degree
Master's Degree Professional Degree (Dental, Law) Doctoral (Ph.D., Ed.D., E.A.)
Other None Some college credit
 
Do either of your parents hold a Bachelor's Degree? Yes No
 
EMPLOYMENT CLASSIFICATION
Employed full-time Employed part-time, over 15 hours Employed part-time, 15 hours or less
Homemaker Unemployed Other
No response  

RESIDENCY CODES
In-District
In-State
U.S. Citizen
Out-of-State
If in-district or in-state, please indicate how long (months)

I understand that withholding or falsifying information on this application may result in ineligibility for admission to or dismissal from the participating colleges. I further certify that all information on this application is complete and correct.

Type full name:
Signature
Date

APPLICATION PROCEDURES
All students who wish to enroll in the cooperative on-line degree program must submit the following information:
  1. Official transcript(s) from the high school(s) attended.
  2. Official transcript(s) from other colleges or universities attended.
  3. An assessment test is required for all new full-time students.
  4. All AA & AS students are subject to the Provisional Admission Standards.

No person shall be denied admission on the basis of age, disability, marital status, military status, national origin, race, religion, sex or other legally protected status.



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