Readmission for Returning Students

GENERAL INFORMATION

Anticipated Enrollment Term * Summer 2019 Fall 2019 Spring 2020 Summer 2020 Fall 2020 Spring 2020

Last 4 of Social Security Number

First Name *

Last Name *

Phone *

Email *

Gender * Male Female I Choose not to Respond

Birthdate *

What Degree or Certificate are you seeking at Triton College? (Select ONLY one Degree or Certificate Program below)

Certificate

Associate in Arts Degree

Associate in Fine Arts Degree

Associate in Science Degree

Associate in Applied Science Degree

Associate in General Studies Degree

HOME ADDRESS

Address *

Apartment/Unit

City *

State*

Zip Code *

RACIAL/ETHNIC
NOTE: This information is requested solely to determine compliance with federal civil rights law, and your response will not affect consideration of your registration. By providing this information, you will help assure that this program is administered in a non-discriminatory manner.

Are You Hispanic or Latino (Or are You of Spanish Origin)? * Yes - MOSTLY Hispanic or Latino (or of Spanish Origin) Yes - SOME Hispanic or Latino (or of Spanish Origin) No - NOT AT ALL Hispanic or Latino (or of Spanish Origin) I Choose not to Respond

Are You from One or More of the Following Racial Groups? * (Select ALL that apply from the first five check boxes OR Select "I Choose not to Respond" check box ONLY) American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White I Choose not to Respond

Which one of the Racial Groups you selects above is your Primary Race? * American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Pacific Islander White I Choose not to Respond