Have you attended Delta College in the past?
Permanent Address - Number, Street, & Apt #
Social Security Number
Race - check all that apply
Legal Resident Of
If Other Michigan County, Please Specify
Length of Time in the Above Selected County (months/years)
If time is less than 3 months, indicate former county
United States Citizen
If Non United States Citizen - Home Country
Permanent Resident Green Card Number
Name of High School /Adult Ed Center/ Alt School
High School End Year
Emergency Contact & Relationship
From the below Options, I would like
POL103 T/Th 9:00AM-12:20PM
LW221 M/W 10:30AM-12:25PM
ABS111 M/W 9:00AM-10:15AM
LW221 T/Th 10:30AM-12:25PM
ABS111 T/W 9:00AM-10:15AM
Some of this information is requested for federal and state government reporting requirements, and/or needed for transcripts verification. The use of this information will comply with all governemnt regulations prohibiting violation of privacy rights.
By submitting this form, I certify that I answered all questions on this application truthfully, and that I have read and understand the information. I will take responsibility to understand and comply with Delta College policies and procedures. I also understand that incorrect or incomplete information by me may result in delay, denial, or withdrawal of admissions, financial assistance and continued attendance.