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Online Application
Please enter your information in each of the following sections. Fields with a red asterisk (*) are
required and must be completed before you can submit your application. Additional questions may
become required based on your answers to a previous question.

Student Record
Have you previously applied?
If any of the following are true, please answer this question YES to prevent creating a duplicate in the system.
Are you a returning student?
Were you enrolled while attending high school?
Have you attended JC as a Guest student?
Have you attended Kid's College or a similar event?

No

Name Information
Legal First Name*

James
Legal Middle Name
Cleveland
Legal Last Name*
Davis
Suffix
II
Former Name
Please list only your former last name in this box.
Examples of former last names include maiden names as well as those from previous marriages.

Birth Date*
(mm/dd/yyyy)

9/3/1997
Legal Gender*

Male
Are you serving/have you served in the Military?
Please provide a copy of your DD-214 for potential transfer credit evaluation.

No
Eligible for Military educational benefits?
No
Are you the spouse or dependent of a current service member, or recently discharged veteran?
No

Address & Phone Information

JC is FERPA compliant and only releases information to authorized institutions. To not have your directory
information released go to www.jccmi.edu/norelease.

Email Address*

jamescd566@gmail.com
Check if address is outside of U.S. or Canada
No
Mailing Address*
4201 Callahan Rd
PO Box
City*

Albion
State/Province
Michigan
Zip/Postal Code
49224-9196
Message Phone
Message Phone number is a number that JC may leave messages(voicemail, text messages and/or verbal messages with
any person who answers at this number) with specific information related to JC (course enrollment, appointments, advising,
financial aid, payments, admission, etc.).
Format: 1234567890 (no dashes)

517-581-6684
Home Phone*
Format: 1234567890 (no dashes)

517-240-6052
Cell Phone
Format: 1234567890 (no dashes)

Citizenship Information
Is English your native language*

Yes
Native Language
If your native language is not listed, please choose Other form the list.

Are you a US Citizen or Permanent Resident?

Yes
Birth Country
United States

Optional Ethnic Information

This section is voluntary. Demographic information is reported to the U.S. Office for Civil Rights under Title VI of the
Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972. It is not used in admissions decisions,
and will not be used in a discriminatory way for participation in, access to, or benefits of programs or services of the
College.

Ethnicity

Non-Hispanic/Latino
Regardless of your answer to the prior question, please check one or more of the following groups in which you
consider yourself to be a member:

American Indian or Alaska Native

No
Asian
No
Black or African American
No
Native Hawaiian or Other Pacific Islander
No
White
Yes

Optional Disability Information

Do you have a documented disability that requires accomodations?
For example workstation modification or a sign language interpreter.

No

Please enter your information in each of the following sections. Fields with a red asterisk (*) are
required and must be completed before you can submit your application. Additional questions may
become required based on your answers to a previous question.

Attendance Dates & Course Load

Student Type*
Dual Enrolled are high school students currently or previously enrolled at Jackson College as a dual enrolled high school
student and would like to attend Jackson College after high school graduation

Undergraduate
When do you plan to start college?*
2015 Fall (August - December)
Expected Enrollment per Semester*
Half Time (6-8 credits)

Educational Program
Area of Study*

Arts and Communications Career Pathway

What is your program of study?*
Graphic Design - Associate
What is your primary reason for attending
Associate Degree

Campus Plans & Request for Information

Do you plan to apply for Financial Aid?

Yes
Are you interested in campus housing?
No
Do you plan to apply for an honors program?
Phi Theta Kappa (PTK)

No
Please enter your information in each of the following sections. Fields with a red asterisk (*) are
required and must be completed before you can submit your application. Additional questions may
become required based on your answers to a previous question.

High School or Home School Information

To find your high school

1. Select the country in which the school is located
2. If the school is in the United States or Canada, select the State/Province in which the school is located.
3. Type the City name
4. Click Search
5. Choose the School from the Results drop down list
6. Click Select

If you attended a Career Center, Vocational Education Center, or Technology Center please list this as a secondary
school.

When using the city search, please note that all words are spelled out except if the city starts with Saint as in these
two examples St Louis and Sault Saint Marie.

High School 1
High School
Enter information about your school's location and click 'Search' to pick your school from a narrowed list.

Springport High School (233485)

Unlisted School Name and Address
If you cannot find your high school, or you were home schooled, please enter the school name and address below.
Otherwise, leave this area blank.

Actual/Anticipated Graduation Year

2015
Actual/Anticipated Graduation Month
May
Self-reported GPA
2.0400000000

Career / Technology Center

Have you attended one of the following career/technology centers? (check all that apply)

Hillsdale Workforce Development and Technology Center (HWDTC)

No
Jackson Area Career Center (JACC)
No
LISD TECH Center (LISD)

No

High School Graduation

Did or will you graduate high school?

Yes
Which did/will you receive from your high school?
High School Diploma

College Credit
Have you attended other colleges?

No
Are you currently enrolled in college?
No
Select Add College to list each college/university at which you have taken courses for credit. Please have an official
transcript sent from each institution as soon as possible.

Please enter your information in each of the following sections. Fields with a red asterisk (*) are
required and must be completed before you can submit your application. Additional questions may
become required based on your answers to a previous question.

Extracurricular Activities & Interests (Optional)

Please list your principal extracurricular, community, volunteer and family activities and hobbies. Include specific
events and/or major accomplishments such as musical instrument played, varsity letters earned, etc. Select Add
Extracurricular Activity for each separate activity you would like to include on your application.

Extracurricular Activity 1
Name*

Arts
Do you plan to participate in college?
Yes

Extracurricular Activity 2

Name*

Band/Orchestra
Do you plan to participate in college?
Yes
Please enter your information in each of the following sections. Fields with a red asterisk (*) are
required and must be completed before you can submit your application. Additional questions may
become required based on your answers to a previous question.

Additional Information
What Influenced you to apply?

Affordability

Certify & Submit

Please affirm the following before you submit your application.

Do you certify the following?*

I understand that once my application has been submitted it may NOT be altered in any way.

Yes
Do you certify the following?*
The information I have provided on this application is correct and complete to the best of my knowledge.

Yes
The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your
confirmation that the application you have filled out is your own work and the information is factually true. Once you
type in your name and the date, this will count as your electronic signature.

Signature*

James C Davis
Signature Date