Delta College logoDelta College: Serving Bay, Midland, and Saginaw counties since 1961

Bootcamp Admissions Application

Have you attended Delta College in the past?


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Last Name
First Name
Middle Initial
Maiden Name
Former Name
Permanent Address - Number, Street, & Apt #
City
State
Zip Code
Cell Phone
Home Phone
Business Phone
Social Security Number

Gender


Birthdate
Ethnicity


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Race - check all that apply





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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


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If Non United States Citizen - Home Country
Visa Type
Permanent Resident Green Card Number

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Educational Plans



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Name of High School /Adult Ed Center/ Alt School
High School End Year

Emergency Contact & Relationship
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From the below Options, I would like


 

Option A

POL103      T/Th  9:00AM-12:20PM

LW221 M/W   10:30AM-12:25PM

ABS111      M/W   9:00AM-10:15AM

Option B

LW221 T/Th  10:30AM-12:25PM

ABS111      T/W   9:00AM-10:15AM

 

 

Verification

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.


1961 Delta Road, University Center MI 48710 | 989-686-9000 | info@delta.edu
Delta College is an Equal Opportunity Organization, committed to excellence through inclusiveness and diversity.
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