2/25/2019 Mountain Empire Community College — Student Print

Application Student Print

Con rmation number: 4088-002193-5-02252019-00236877-00161717
Date submitted: February 25, 2019 at 2:59:30 AM

1. THE BASICS

Legal Name

Last name:
Corcoran

First name:
Stephen

Middle name:
D

Su x:

Do you have another name you prefer to be called?

No

Other Important Information

Birthdate:
10/31/1964

Social Security number (SSN) or Taxpayer Identi cation number (TIN):

***-**-2029

What is your gender identity?

Male

What is your racial or ethnic identi cation?

Hispanic or Latino/a

Are you Hispanic or Latino?

Yes

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Have you ever applied, attended, or worked at any community college in Virginia?
Yes

Student ID (EMPLID) number:

7475562

2. COMMUNICATING WITH YOU

Mailing Address

Country:
United States

Street/PO Box:
4117 Essex Court

City:
ADELL

U.S. state/territory:
WISCONSIN

Zip code:
53001

Is this also your permanent/home address?

Yes

Additional Contact Information

Has Virginia been your home for the past 12 months or more?

Personal e-mail address:

zavagjwx@besttempmail.com

Telephone:
(802) 316-0942

Type:
Work

Cell phone number:

(414) 324-6464
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Would you like to get important updates from the college by text message?
No

If you plan to apply for nancial assistance, Federal Financial Aid guidelines require that we obtain
your voluntary consent to use electronic means, such as email, to provide you with information:
I agree and have reviewed the guidelines

3. YOUR EDUCATION
Which of the below describes your current high school education?
I do not have a GED/High School Diploma and I am not currently attending high school

Last date attended:

01/2018

Highest grade completed:

3

College/University Information

Have you attended any other college(s)?

No

Program of Study

I plan to earn a degree, certi cate, or diploma at Mountain Empire Community College:
No

I plan to start classes in:

2019 Summer (05/31/19 - 08/05/19)

4. YOUR MILITARY SERVICE

Military Information

Have you served or are you currently serving in the U.S. military?
No

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Are you a dependent or spouse of someone who is currently serving or has served in the U.S.
military?
No

5. YOUR BACKGROUND

Parent(s) Education Level

What best describes your parent(s) highest level of education?

Parent 1:
Did not nish high school

Parent 2:
Unknown (this parent did not raise me)

Residency

What is your current status?

Native U.S. Citizen (born in U.S. or born abroad to U.S. Citizen)

What is your primary spoken language?

English

Do you want to apply for in-state tuition rates?

No

- End of Document -

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