NHTI-Concord's Community College Application for Admission

APPLICATION FOR

ADMISSION



 (FA = Fall SP = Spring  = Summer) _______ ________

NAME

Last _______________________________________________ First ____________________________ Middle____________

List other names used on school records _____________________________________________________________



Street _________________________________________________________ City ____________________ State _______ Zip _______



Street _________________________________________________________ City ____________________ State _______ Zip _______



Home __ __ __ - __ __ __ - __ __ __ __ Cell __ __ __ - __ __ __ - __ __ __ __

 _____________________________________________________________________________________

___ ___ ___ - ___ ___ - ___ ___ ___ ___

For compliance purposes, the Community College System of New Hampshire and its Colleges collect names and social security numbers from all students aending the

college. For example, the Internal Revenue Code requires the college to produce a 1098-T tax form. The college’s use of social security numbers will be limited to legimate

educaonal purposes. The college will exercise due diligence to protect the student’s social security number and will not disclose it to anyone outside the college, except as

authorized by federal or state laws or applicable policies.

*    

MO DAY YR

 Yes No

 American Indian/Alaskan  Asian  Black or African American

 Nave Hawaiian/Pacic Islander  White

* Answering quesons so marked is oponal. They are used for stascal purposes only; your responses will not aect the admission decision.



:

:

 Ocial high school transcript even if you received a GED or HiSET

NOTE: It is your responsibility to request that ocial transcripts be mailed

directly to the NHTI Admissions Oce. Each program has addional, specic

admission requirements which are listed on the academic program pages

at nh.edu/academics/. Applicants are responsible for knowing these

requirements, any specic deadlines, and subming appropriate documents as

noted.

 SAT or ACT scores (recommended but not required)

 High School Equivalency Exam Scores (if applicable)

 Prospecve Major/Degree Program checked

 New Hampshire Residency secon completed by New Hampshire

residents only (see back of this applicaon)

 Request for New England Regional Student Program completed and

signed by out-of-state New England residents only

 Signature of Applicant

:

 Complete all of the items listed at le under “All Applicants” AND

 Ocial college transcripts requested (see Note at le)

:

 

 Please supply proof of US permanent residency status.

 

 Please supply copy of I-94.

 

See addional Internaonal Admission Requirements at

nh.edu/admissions/general-admission-requirements/internaonal-students

Send to: 

NHTI─Concord’s Community College

31 College Drive • Concord, NH 03301-7412

Phone: (603) 230-4011 or 1-800-247-0179

Fax: (603) 230-9302

PLEASE TYPE OR PRINT IN INK

  YES  NO  ______________________

  YES  NO

  Permanent Resident  Refugee or Asylee  Internaonal Student

If you are an , complete this informaon below:

 _______________________________  _____________________________

(Applicaon for F-1 Student Visa), please include permanent address in your home country.

Please print your permanent address in your home country in proper mailing format:

______________________________________________________________

Please indicate the person who should be contacted in medical emergencies:

NAME OF: (check one)  Parent  Guardian  Spouse  Other ______________________

Last ___________________________________________ First__________________________________________

STREET ADDRESS

Street ________________________________ City ___________________ State _________ Zip _____________



Home

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

Cell

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

Yes No If yes, provide dates: _______________

Yes No Dates /Program: __________________

 Yes No (See Academic Amnesty at nh.edu/academics/requirements-policies/academic-amnesty)

 Yes No

If yes, to which New Hampshire Community College was the course(s) connected? ___________________________



School Name ____________________________________ Address _________________________________

City _______________________________________________ State ______________ Zip____________

High School Graduaon Date ________ / _________/ _________ or Year High School Equivalency Diploma Awarded _________________

MO DAY YR

 DATES ATTENDED DEGREE

Name _____________________________ City __________ State _____ _______________ _____________________



 Family/Friend  Facebook  Google  HS Counselor  College Fair  NHTI Website

 NHTI Mailing  NHTI Alumni  Newspaper Ad  TV Ad  Radio Ad  Other _________________________



Yes No

Yes No

If yes, which VA educaon benet will you be using (Please check one):

Post 9/11 (CH33) Dependent (CH35) Reserve/Guardsman (CH 1606/07) Voc-Rehab (CH31) Acve Duty



Degree and Professional Cercate Programs

 If you are applying for either General Studies or Liberal Arts but you plan to

pursue another major here at NHTI, please indicate that intended major here:

_______________________________________________

* Begins in the Fall semester only. ** Begins in the Summer semester only.



 English

 General Studies

 Liberal Arts

 Visual Arts



 Accounng  Business Administraon



 Dental Assisng*

(Professional Cercate)

 Dental Hygiene*

 Diagnosc Medical Sonography*

(Professional Cercate)

 Health Science

 Health Science with a Concentraon

in Nutrion and Wellness

 Nursing (RN)*

 Nursing LPN to RN Compleon Opon**

 Orthopaedic Technology*

 Paramedic Emergency Medicine*

 Radiaon Therapy*

 Radiologic Technology*



 Hospitality and Tourism

Management

 Recreaon and Leisure Studies

 Sports Management



 Addicon Counseling

 Criminal Jusce

 Human Service

 Paralegal Studies

Educaon

 Early Care & Educaon for Young

Children with Disabilies

 Early Childhood Educaon

 Educaon Degree



Science

 Biology

 Environmental Sciences

 Landscape and Environmental Design

 Sustainable Agriculture

Technology

 Animaon and Graphic Game

Programming

 Computer Engineering Technology

 Informaon Technology - Networking

 Informaon Technology - Soware

Development

Engineering

 Advanced Manufacturing Process

Technology

 Animaon and Graphic Game

Programming

 Architectural Engineering

Technology

 Civil Engineering Technology

 Computer Engineering Technology

 Electronic Engineering Technology

 Industrial Design Technology

 Manufacturing Engineering

Technology

 Mechanical Engineering Technology

 Robocs and Automaon

Engineering Technology Degree

Mathemacs

 Mathemacs

Cercate Programs

Most NHTI Cercate Programs are nancial aid eligible (Those that are not nancial

aid eligible are marked with +). If you intend to apply for nancial aid for one of these

programs now or in the future, YOU MUST submit an ocial, nal high school transcript,

or the equivalent documentaon that demonstrates high school compleon, to the NHTI

Admissions Oce.



 Mindful Communicaons



 Accounng (Basic)

 Accounng (Advanced)

 Management

 Sports Management



 Coaching

 Computed Tomography (CT)

 Legal Nurse Consultant

 Orthopaedic Technology*

 Radiaon Therapy*



 Digital Communicaons

 Event/Conference Management

 Hotel Administraon

 Recreaon and Leisure Studies

 Sports Management

 Travel and Tourism

 Wedding Planning Management



 Advanced Human Service+

 Human Service+

 Paralegal Studies

 Substance Use Disorder Treatment

(SUD Tx)+

Educaon

 Career and Technical Educaon

Alternave Cercaon

 Early Childhood Educaon

 Early Childhood Educaon (Advanced)

 Early Childhood Educaon Entry Level

 Educaon

 English Speakers of Other Languages

 Special Educaon

 Young Children with Ausm and

Exceponalies



Environmental Science

 Landscape Design  Sustainable Agriculture Technology

Technology

 Advanced Soware Development+

 Entry Level Soware Development+

 Game Development Programming

 IT Entry Level Networking+

 IT Hardware and Soware+

 Linux+

 IT Microso Servers+

 IT Network Associate+

 IT Security+

 IT Soware Development

 IT Tech Support

 IT Virtualizaon+

 IT VoIP (Voice Over IP)+

Engineering

 Advanced Manufacturing Processes*

 Applied Career Fundamentals for

Advanced Manufacturing

 Automaon

 Building Inspector and Plans

Examiner+

 Computer Aided Design/

Architectural Concentraon

 Computer Technology programming

(Advanced)

 Electronic Technology

 Game Development Programming



Degree Programs

 Accounng

 Addicon Counseling

 Business Administraon

 Criminal Jusce

 Early Childhood Educaon

 English

 General Studies

 Hospitality and Tourism Management

 Liberal Arts

Cercate Programs

 Accounng (Basic)

 Accounng (Advanced)

 Early Childhood Educaon

 Early Childhood Educaon (Advanced)

 Educaon

 Event and Conference Management

 Hotel Administraon

 Management

 Medical Coding

 Special Educaon

 Substance Use Disorder Treatment (SUD Tx)

 Travel and Tourism

 Wedding Planning Management



The New Hampshire Dual Admissions Program in conjuncon with the University System of New Hampshire allows a student to enroll at NHTI, and be admied into one of the

University System of New Hampshire Instuons (Granite State College, Keene State College, Plymouth State University, University of New Hampshire - Durham or University of

New Hampshire - Manchester) at the same me. Students must meet with an NHTI advisor to review Dual Admission eligibility requirements and complete a Dual Admission

Advising Contract. By selecng Yes, I am requesng enrollment in the NH Dual Admission Program between NHTI, Concord’s Community College and the University System of New

Hampshire. I understand that acceptance into the USNH instuon is conngent upon meeng eligibility requirements and subming any required Dual Admission documents.

 YES, I am interested.  NO, I am not interested.





(See nh.edu/student-resources/bursar)

 Month and Year student

moved to New Hampshire ________________________________ OR  I have always lived in New Hampshire

Month Year



The In-State Tuion Program allows for out-of-state students whose town or city borders are within or conguous to a 50-mile radius of the NHTI

campus to receive in-state tuion. Eecve Fall 2017.

I am a resident of ______________________________________________________________________ and request to be considered for ISTP50.

Town/City State



(See nh.edu/student-resources/bursar)

The New England Regional Student Program enables a resident of a New England state to enroll in a public college or university in the six state

region at reduced rates for certain degree programs if:

• The program is not available in the home state public instuons; and/or

• The out-of-state public instuon is nearer to the student’s residence than the in-state instuon that oers a similar program.



I am a resident of _____________________________________________________________________ and request to be considered for NERSP.

Town/City State



The informaon provided by the applicant on this admission applicaon form shall be held condenal to the extent determined by

Federal law and NHTI policy. NHTI─Concord’s Community College, reserves the right to deny admission to any applicant, who, in the judgment of

College ocials, does not qualify for admission. NHTI also reserves the right to require withdrawal of a student who does not sasfy the ideals of

cizenship, character, or scholarship.

In accordance with the terms and condions set forth in its publicaons, and if accepted, I agree to abide by the rules and regulaons set

forth in the publicaons and in the student handbook.

I also agree that NHTI has permission to use any College-sponsored pictures in which any likeness appears.













 

Signature of Applicant ________________________________________________ Date _______________________

Signature of Parent or Legal Guardian

(if student is under 18 years old) ________________________________________ Date _______________________



NHTI is commied to creang and maintaining a posive and producve learning environment for students, a professional seng for its employees, and a community

atmosphere grounded in mutual respect, dignity, and integrity. In light of these objecves, NHTI prohibits all manner of discriminaon in the administraon of its

employment programs and pracces on the basis of unlawful criteria including race, color, religion, naonal or ethnic origin, age, sex, sexual orientaon, marital status,

disability, gender identy or expression, genec informaon, and veteran status, as dened under applicable law. This statement is a reecon of the mission of NHTI and

refers to, but is not limited to, the provisions of the following laws, as amended: Title VI and VII of the Civil Rights Act of 1964, as amended; The Age Discriminaon Act of

1967 (ADEA); Title IX of the Educaon Amendment of 1972; Secon 504 of the Rehabilitaon Act of 1973; The Americans with Disabilies Act of 1990 (ADA); Secon 402 of

the Vietnam Era Veteran’s Readjustment Assistance Act of 1974; NH Law Against Discriminaon (RSA 354-A); Genec Informaon Nondiscriminaon Act of 2008

Inquiries regarding discriminaon may be directed to Laura Pantano, NHTI Title IX and Civil Rights/Equity Coordinator, SC229 Student Center, NHTI, Concord’s

Community College, 31 College Drive, Concord, NH 03301-7412, (603) 271-6484 x4128; Email: nh[email protected]; or Sara A. Sawyer, Director of Human Resources for

the Community College System of NH, 26 College Drive, Concord, NH 03301, 603-230-3503. Inquiries may also be directed to the US Department of Educaon, Oce of Civil

Rights, 8th Floor, 5 Post Oce Square, Boston, MA, 02109-4557, 617-223-9662, FAX: 617-223-9669, TDD:617-223-9695, or Email: [email protected]; the NH Commission

for Human Rights, 2 Chenell Drive, Concord, NH 03301, 603-271-2767, FAX: 603-271-6339; and/or the Equal Employment Opportunity Commission, JFK Federal Building,

475 Government Center, Boston, MA, 02203, 617-565-3200 or 1-800-669-4000, FAX: 617-565-3196, TTY: 617-565-3204 or 1-800-669-6820.

NHTI─Concord’s Community College is one of seven colleges

in the Community College System of New Hampshire.

2019-2020