Cerritos College Student Number:

Birth Date:

Name of Candidate:
Last:

First:

Middle:

Address:
Street:Unit #:

City:State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WYZip:

Phone Number:

Email:

Do you have a valid driver's license?YesNo

List any accident or tickets your record may show:

High School Attended:

Did you graduate?  YesNoIf yes, what year?

Did you participate in a high school automotive program?YesNo

Have you completed any college classes at Cerritos College?YesNo

Have you completed college classes at another school?YesNo

Where?Dates Attended:to

Classes taken:

In high school or college, what is the last Math course you completed?
Basic Math
Pre-Algebra
Algebra
Geometry
Intermediate Algebra

Have you taken the English and Math Assessment Exams at Cerritos College?

YesNo

Have you attended the New Student Orientation at Cerritos College?

YesNo

Other Educational Experience (Military, Seminars, Etc.):

Work Experience:

Career interest:

Initials of Applicant: