Application Overview

2016-2017 Police Academy

Dear Police Recruit Applicant,

Thank you for your interest in attending our 28th Basic Course for Police to be conducted April 2016

– March 2017 through our Rural Police Training Academy.

Please carefully review the materials, forms and requirements contained in your RPTA application

packet. It is important that you understand and submit all required documentation and payments prior

to the start of classes. The class is filled in the order completed applications are received.

Several critical items to assist you in your enrollment decision and application are noted here.

Tuition for the 2016-2017 Police Academy is $3,950. A $350, non-refundable fee is

submitted with your completed application. The tuition balance of $3,600 must be paid in full

prior to the start of the first class. The college does not offer loan or payment plans. Also VA,

TAP or PELL funding you may be eligible for may not be applied to defer your tuition

payment. Cash, check, money order or credit card payments are accepted and payable to

“GCC”. Tuition includes texts. Uniforms, firearms and range ammunition are the

responsibility of sponsoring Departments and/or individual recruits. Veterans and Financial

Aid questions should be directed to the Financial Aid Office, 585-343-0055 ext. 6223.

Recruits are encouraged to take advantage of the Credit Option, providing permanent

transferable college credits. Sworn recruits can earn up to 22 college credits and Pre-

Employment recruits may earn 16 credits. No additional fees are required. Enrollments are

distributed over summer and fall terms enabling eligible recruits to receive both TAP and

PELL grants. If you select the credit option, complete items A & B below.

Two Certificates of Residency must be secured from your County Clerk’s office. The first

should be secured after March 15, 2016 and submitted to the College by April 15, 2016. The

second Certificate should be secured after July 1, 2016 and submitted by August 1, 2016.

(Please check your county’s requirements. Some counties require that you apply in person at

the Clerk’s office.)

You must provide proof of your Immunizations. Refer to the requirements based on your age.

If your records are not available, you may be required to receive a current vaccination. Please

consult our Health Office with any questions at Ext. 6835.

If you have any questions regarding the Police course please contact Doug Brooks at

rpolice@genesee.edu. For enrollment requirement questions please contact The BEST Center

directly at 585-345-6868.

We look forward to your training with us and establishing your new career as a police officer.

Sincerely,

Douglas C. Brooks

Director

Rural Police Training Academy

Required Forms & Special Notices

Application Checklist

Dear Police Recruit Applicant:

Thank you for your interest in our Rural Police Training Academy Basic Course for Police or Pre-Employment Basic. The

academy begins April of each year and ends the following March. Classes meet Tuesdays and Thursdays from 6:30 p.m.-10:30

p.m. and Saturdays, 8:00 a.m.-5:00 p.m, as well as a number of Wednesdays throughout the year. Tuition (which includes all

texts) is $3,950. A $350 non-refundable deposit must accompany your paperwork and should be submitted as soon as possible to

reserve a spot in the next academy.

Recruit Name: _______________________________________________________________________________________

Phone Cell: __________________________________________ Home: ________________________________________

Email Address: ______________________________________________________________________________________

The $350 deposit, this checklist and the following completed forms should be enclosed and mailed to: RPTA, GENESEE

COMMUNITY COLLEGE, ONE COLLEGE ROAD, BATAVIA, NY 14020, ATTN: D. Brooks – Basic Course.

Recruit Information Form

Health Evaluation Form

Physical Evaluation Form

**Sworn ONLY – Police Officer Certification of

Initial Employment

**Pre-Employment ONLY – Pre-Employment

Student Advisory Notice

Agreement to Conduct Code

Credit Confirmation Request

Application Acknowledgement

**Pre-Employment ONLY – Background

Investigation Waiver

Certificate of Residence (secured after March 15)

GCC Health Center Form

GCC Health History Form

GCC Health Insurance Form

GCC Application (Check Summer 2015)

**Pre-Employment ONLY – Reference letter

from Chief/Sheriff in your community or county

to support your application

Included for your information are Physical Fitness Training Standards Form,Veterans’ Education Benefits, Immunization

Documentation Instructions and the College Credit Options.

It is imperative that you complete this paperwork ASAP, by March 1, if possible (MAXIMUM CLASS SIZE: 27). Tuition

must be paid in full by the time the class begins.

Minimum age is 19 to insure that the candidate reaches the age of 21 in the two-year period that the Pre-Employment certificate

is valid. No maximum age for admission, as long as the candidate can pass all entrance and exit physical testing requirements.

No criminal history whatsoever. A background investigation will be conducted by the Rural Police Training Academy.

A mandatory physical fitness agility pre-test is scheduled for a Saturday in April. Sneakers, shorts, sweats, etc. are required for

this day. You must meet the minimum requirements as per Physical Fitness Training Standards form (enclosed) or you

will NOT be allowed to enter the Basic Course. You will be placed on a preferred list for the next class.

If you are denied access to this course due to class size, but otherwise complete all the required paperwork properly, your deposit

will be returned to you and your name will be placed on a preferred list for the next Basic Course.

If you have any questions, please call Douglas Brooks at 585-343-0055 ext. 6289 or use email: rpolice@genesee.edu. Thank you

for your interest and we hope you will give us this opportunity to serve your educational needs.

Sincerely,

Douglas C. Brooks, Director

Rural Police Training Academy

GENESEE COMMUNITY COLLEGE

Basic Course for Police

Recruit Information Form

Social Security No.______________________________________ Date of Birth___________________ M or F

Last Name__________________________________________First Name________________________ MI___________

Home Address______________________________________________________________________________________

City__________________________State________ Zip Code____________ Home/Cell Phone_____________________

Work Phone _______________________ E-Mail Address__________________________________________________

Department Information:

Department____________________________________________________________ Date of Hire__________________

Department Head____________________________________________________________________________________

Address____________________________________________________________________________________________

Department Phone___________________________________________________________________________________

Explain briefly your police or military experience:

_________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

___________________________________________________________________________________________________

Would you like to volunteer to be a Class Team Leader for the Basic Course (circle one)? YES NO

Part 6000 Medical and Physical Fitness Standards and Procedures for Police Officer Candidates Page -12 & 13- (b) Elements of the test battery. Elements of the test battery to be used for physical fitness screening are described below. Although these elements may not be directly representative of essential job functions to be performed by an entry-level police officer, such elements do measure the candidate's physiological capacity to learn and perform the essential job functions. The minimum scores for employment as an entry-level police officer as set forth below represent the 40th percentile of fitness. If a candidate does not successfully score to the 40th percentile of fitness for each of the elements of the test battery, the candidate shall not be deemed to have successfully completed the physical fitness screening test. Nothing herein shall preclude an administrator of such screening test from substituting an element of the test battery, which such administrator has determined and validated to accurately assess the candidate’s physiological capacity to learn and perform essential job functions. The 1.5 mile run shall only be administered to such individuals who have successfully completed each of the other two elements of the test battery (sit-up and push-up). Sit-up Muscular endurance (core body) - The score indicated below is the number of bent-leg sit-ups performed in one minute. Push-up Muscular endurance (upper body) - The score below is the number of full body repetitions that a candidate must complete without breaks. 1.5 Mile Run Cardiovascular capacity -

The (time) score indicated below is calculated in minutes:seconds. (emphasis added)

Age: Gender Test Age Sit Up Push Up 1.5 Mile Run

Males 20-29 38 29 12:38

30-39 35 24 12:58 40-49 29 18 13:50 50-59 24 13 15:06 60+ 19 10 16:46

Females 20-29 32 15 14:50

30-39 25 11 15:43 40-49 20 9 16:31 50-59 14 - 18:18 60+ 6 - 20:16

Version 2011 (9/14/2011)

RURAL POLICE TRAINING ACADEMY Health Evaluation

Last Name________________________________________________First________________________________________Middle_____________

Social Security No.________________________________________________________Date of Birth_____________________________________

Address (permanent)______________________________________________________________________________________________________

City__________________________________________________________State_______________Zip_______________Phone________________

Address (work)___________________________________________________________________________________________________________

Department______________________________________________________________________________________________________________

City________________________________________________State_______________Zip_______________Phone__________________________

Person to be notified in case of emergency _______________

Relation ________ Phone _______________

Address _______________

Do you have a personal physician? _______________

Address _________ Phone _______________

Are you presently receiving medical or mental health services? No Yes

If yes, please specify: _______________

Do you have any chronic diseases or disabilities? No Yes

If yes, please specify: _______________

Do you take any medication? No Yes

If yes, please list: _______________

Do you have any allergies? No Yes

If yes, please specify: _______________

Do you have any health problems that would prevent

you from participating in P.T. education? No Yes

If yes, please specify: _______________

Do you have any health problems that your instructors

should know about? No Yes

If yes, please specify: _______________

Do you consider your health: Excellent Good Fair Poor

The foregoing information is accurate to the best of my knowledge.

Signature_________________________________________________________________________Date___________________________________

PHYSICAL EVALUATION FORM

Rural Police Training Academy Genesee Community College

One College Rd Batavia NY 14020

(585) 343-0055 Ext. 6253

PHYSICAL FITNESS STANDARDS FOR BASIC COURSE FOR POLICE RECRUIT TRAINING CLASS

The attached Physical Fitness Standards are required of each Recruit Police Officer attending the Basic Police Training Course at the RPTA. Each Recruit Police Officer will be performing these types of exercises at various times during the course. Additionally, Recruit Police Officers will be required to participate in other strenuous group exercises and activities. Using the Physical Fitness Standards as a guide, please evaluate the Recruit Police Officer’s physical well being and ability to perform strenuous physical exercises. I have examined Recruit Police Officer______________________________________. (Full Name-Printed Clearly or Typed) This person IS IS NOT (Circle the correct response) physically able to participate in all of the strenuous physical exercises noted above and on the attached Physical Fitness Standard’s sheet. Physician’s Name Physician’s Address Physician’s Signature (Original – No Stamp) Date This form is to be returned to the RPTA by the Recruit Officer with all registration materials.

SPECIAL NOTICE VETERANS EDUCATIONAL BENEFITS

The RPTA’s Basic Course for Police is approved by the New York State Division of Veterans’ Affairs for the training of veterans and other eligible persons. Veterans, individuals serving in the Reserves or National Guard, and surviving spouses or dependents of deceased or disabled veterans may be eligible for VA Educational Benefits for enrollment in the Basic Course for Police. If you believe you may qualify, complete and submit a VA application NOW! Certification can be obtained 120 days prior to the start of the educational program. For assistance and VA application forms call GCC Financial Aid Office directly at 585-343-0055 Ext. 6223. Do not delay. Apply now to ensure timely processing of the benefits you may be entitled for this training program.

New York State Division of Criminal Justice Services PRE-EMPLOYMENT POLICE BASIC TRAINING PROGRAM – STUDENT ADVISORY NOTICE

COPYRIGHT © 2007 NEW YORK STATE DIVISION OF CRIMINAL JUSTICE SERVICES (JAN 2007)

THIS FORM IS USED TO ENSURE STUDENTS ATTENDING A PRE-EMPLOYMENT POLICE BASIC TRAINING PROGRAM HAVE BEEN ADVISED OF THE PROGRAM REQUIREMENTS AND RULES AND REGULATIONS GOVERNING TRAINING AND APPOINTMENT AS A POLICE OFFICER. FORMS PRESENTED FOR FILING MUST CONTAIN ORIGINAL SIGNATURES. ALTHOUGH THE BLANK FORM MAY BE DUPLICATED, PHOTOCOPIES OF COMPLETED FORMS, OR FORMS WITH PHOTOCOPIED SIGNATURES WILL NOT BE ACCEPTED. Students in the Pre-Employment Police Basic Training Course must be advised of several conditions of this training program that will affect them during and after attending the program. Schools are required to advise the student of these conditions by the policy established for this program by Division of Criminal Justice Services.

1. Completion of this program is not a guarantee of employment as a police officer.

2. To complete this pre-employment training program, a student must participate in physical fitness training and successfully complete a physical fitness examination.

3. To complete this pre-employment training program, a student must comply with mandated New York State regulations that include: strict attendance requirements; maintaining a notebook; and passing written examination/s.

4. This is a two-phase program. The first phase is conducted pre-employment and the second phase is conducted after appointment as a police officer. Each individual phase of this training program must be completed as a single and cohesive unit. This means that students must complete the phase of the program at one institution. The following phase may be conducted at a separate institution.

5. Before being appointed as a police officer, a person must complete New York State Civil Service requirements and appointing agency hiring standards (including minimum and maximum age and residency requirements) by taking a written examination and scoring high enough on the eligibility list to be considered for appointment.

6. Before being appointed as a police officer, a person must take and successfully complete a physical fitness examination.

7. Before being appointed as a police officer, a person must submit to a medical examination, which may include drug screening.

8. Before being appointed as a police officer, a person may be required to submit to a psychological examination.

9. Before being appointed as a police officer, a person with criminal conviction or with a felony conviction may be disqualified from employment.

10. Before being appointed as a police officer, a person may be required to submit to a background investigation.

11. Upon appointment as a police officer, a person will be required to successfully complete additional training. Failure to complete this training will result in denial of certification by the New York State Municipal Police Training Council. This certification is required by § 209-q of the General Municipal Law for police officers to remain in their positions.

12. Pre-employment training will be valid for two years after completion of this program. If a person is not appointed before two years has elapsed, they will be required to attend a Police Refresher Course. After ten years from the date of completion records on the transcript, the training will no longer be valid (this is consistent with the provision of §209-q of the General Municipal Law pertaining to police officers).

ATTESTATION Applicant Attestation: I hereby attest that I have read and understand the above policies regarding the Pre-Employment Police Basic Training Program. I understand that the information in this section s part of a written statement that will be presented to the Division of Criminal Justice Services for filing, and I certify that it is true to the best of my knowledge and belief.

Student Signature

Date

School Director Signature

Date

Rural Police Training Academy

Agreement to Conduct Code

Illegal Drugs and Motor Vehicle Inspections

1. Attending class sessions under the influence of alcohol or illegal drugs: If suspected of

being under the influence of alcohol or illegal drugs (obvious scent of alcoholic beverages on

breath or from person, abnormal behavior, odor indicating recent use of Marijuana, etc.),

the situation will be immediately investigated by a member of the RPTA Staff (Director, Asst.

Director, Lead Counselor or Counselor). If necessary, the recruit under suspicion will be

removed from class immediately and sent home, if so doing can be done safely. Once the

investigation is complete, if the use of alcoholic beverage and/or illegal drug proves to be

positive, that recruit will be immediately terminated from the Academy.

2. Inspection of Motor Vehicles while a Recruit in the Basic Course for Police/Pre-

Employment: During the course of the Academy, there will be instances where a Recruit’s

vehicle will be inspected by Academy Staff for the purpose of pointing out and thereby

preventing Vehicle and Traffic Law violations. While in any Police Academy and throughout

an Officer’s career, he/she should do the best job possible to obey all Laws while on and off

duty, and in this case it would be the Vehicle and Traffic Law of the State of New York. An

Officer can’t very well expect others to obey the law and be able to enforce the law, while

they (The Officer/Recruit) drives a vehicle with violations such as: Expired Inspection or

Registration, improperly tinted windows, unsafe tires or inoperative headlights, tail lights,

brake lights, turn signals etc. With this in mind, the Recruit should be prepared to have their

vehicles inspected by Academy Staff, generally unannounced, at any time deemed necessary

throughout the length of the course.

In submitting my application for the Rural Police Training Academy Basic Course for Police/Pre-

Employment I confirm that I have read the Paragraph 1 & 2 explained above. Further, I understand and

accept the consequences of Paragraph 1 and I give permission for my vehicle (or any such vehicle I am

driving) to be Inspected by Academy Staff as per Paragraph 2.

_______________________________________ ____________________ Print Name Date _______________________________________ Signature

Print name, sign and submit with completed application packet.

RPTA BASIC COURSE FOR POLICE

2016-2017

Recruit

Credit Confirmation Request

I,_________________________________, understand that I may be registered for and receive up

to 16 credit hours as a Pre-Employment Recruit or up to 22 credit hours as a Sworn Recruit in the

following Criminal Justice and Health/PED courses as part of my participation in the RPTA Basic

Course for Police. I also understand that my decision to be eligible for enrollment must be

confirmed, and all required college application, high school/GED diploma, proof of immunization

and certificate of residency forms must be submitted with my RPTA Application. I understand

that I may be ineligible for this college credit option if I do not submit these documents by the

start of the Academy.

I confirm my decision to accept/decline the credit option as checked below:

Accept Decline Credit Hours Course Title

_____ _____ 3 CRJ101 Intro to Criminal Justice

_____ _____ 3 CRJ110 Legal Aspects in Criminal Justice

_____ _____ 3 CRJ112 Police

_____ _____ 3 CRJ206 Criminal Investigation

_____ _____ 3 *CRJ222 Field Studies in Law Enforcement

_____ _____ 3 *CRJ121 Firearms

_____ _____ 3 HED205 Responding to Emergencies

_____ _____ 1 PED132 Beginning Karate

____ _____ Total Credit Hours Accepted & Declined

NOTE: *CRJ222 and CRJ160 require Sworn Certification by a Chief or Sheriff

I am applying for TAP/PELL grants: Yes_____ No______

I am applying for VA benefits: Yes_____ No______

______________________________________ ________________ Recruit Signature Date

______________________________________ ________________ Confirming Academy Official Date

RPTA BASIC COURSE FOR POLICE

2016-2017

COLLEGE CREDIT OPTION

Please review these instructions for the COLLEGE CREDIT OPTION available at no additional cost

through the Basic Course for Police program. Recruits may also qualify for and receive TAP or PELL grant

aid or apply for student loans. The credit option is only available at the start of the Basic Police Course.

Sponsored Recruits are eligible for a maximum of 22 credit hours and Pre-Employment Recruits are

eligible for a maximum of 16 credit hours.

Action 1. Complete the Credit Confirmation Request form.

(If no hours desired, state “0” Totals Hours Requested, sign and date.)

Action 2. Complete the GCC **Application for Admission. Check Summer 2016 Term.

Action 3. Secure an official copy of your High School Transcript or GED Certificate.

Action 4. Review and submit Proof of Immunizations per attached materials.

Those who fail to comply with these New York State laws will be

prohibited from attending classes. Contact the Health Office (585) 345–6835

or fax number (585) 345–6810 with any questions.

Action 5. File an online *FAFSA application(s) if seeking TAP and PELL financial Aid.

Action 6. Return #1-4 with your completed RPTA Application Packet.

Action 7. Secure and submit after March 15th

a Certificate of Residency from your County

Treasurer’s office. (An application form is provided. Note: your County may

require presenting applications in person at the Treasurer’s Office).

*Recruits who believe they are eligible for and are applying for TAP and PELL financial aid must

immediately file FAFSA applications for BOTH the 2015-2016 and the 2016–2017academic years.

(Recruits who filed a 2015-2016 FAFSA AND were enrolled in college courses during the spring 2016

term do not have to re-file a 2015-2016 FAFSA).

Go to www.fafsa.edu.gov to file online. You will also need to secure a pin number for yourself, which you

can do at www.pin.ed.gov

**Recruits applying for financial aid must also check “seeking a degree” on the GCC Application

Considerations for taking for credit:

*If you are a GCC student who has already earned credit in any of the credit courses available through this

RPTA Credit Option program, it may be an opportunity to raise one’s final grade.

*If you do not have a college degree it is an opportunity to secure these credits for use now or in the future

at GCC or another college. It is highly recommended that the courses be taken for credit, even if you are

not currently interested in a degree. In previous academies, some recruits passed on this opportunity only

to come back after they are on the job, seeking advancement and needing the credentials- but it is too late!

*If you have a college degree, but did not take these courses, enrolling now is an easy way to enhance your

qualifications/experience.

*Courses taken for credit are awarded a grade (A-F) which is entered on one’s permanent transcript and can

be transferred to other college credit programs or document learning for job applications or promotions.

Contact The BEST Center 585-345-6868 with questions or for assistance regarding the Credit Option. For

Financial Aid or Veterans Benefits, call the Financial Aid Office at Ext. 6223.

Genesee Community College

Rural Police Training Academy

Basic Course for Police

Pre-Employment & Sworn Recruit Application Acknowledgment

The Basic Course for Police is presented in accordance with provisions of the New York

State Bureau of Criminal Justice Services (DCJS). It is imperative that all recruit

applicants are fully informed and agree to perform all College and DCJS program

requirements. The requirements include:

Time Commitment Be prompt and prepared to attend all training sessions:

General Class schedule Tuesday and Thursday evenings, 6:30-10:30 p.m. and Saturdays,

8:00 a.m. to 5:00 p.m. (with a number of additional Wednesday evenings). Absences

cannot exceed 10% of the total class hours. No excuses allowed for Mandatory Topics

classes: Firearms, Article 35, Physical Agility/Arrest Techniques, Domestic Violence,

Ethics, and Radar/Lidar.

Tuition Commitment

Tuition down payment $350 submitted with completed application packet.

Full tuition balance $3,600 paid in advance of first class session.

Uniform, Firearm and Ammunition Commitment

Pre-Employments – Uniform, leather gear ($1,000 est.)

Sworn Recruits – Uniform, leather gear, weapon ammunition ($2,000 est.)

In submitting my application the Rural Police Training Academy Basic Course for Police

and Pre-Employment, I confirm that I have read, accept and am prepared to fulfill the

obligations listed above.

_________________________________________ __________________

Print Name Date

_________________________________________

Signature

Print name, sign and submit with completed application packet.

Rural Police Training Academy Genesee Community College One College Road Batavia, New York 14020 (585) 343-0055, Ext. 6289 FAX (585) 345-6890 Cell (Brooks) (585) 704-1226 E-Mail: rpolice@genesee.edu

Douglas C. Brooks, Director Richard A. Tiede, Asst. Director

Background Investigation Waiver Have you ever been convicted of a violation of law (Felony/Misdemeanor)? Circle: YES or NO Do not include offenses involving Family Court or Youthful Offender. If yes, you must attach a list of violations with dates of convictions and resultant penalties on a separate sheet of paper. I understand that false statements made herein are punishable as a Class A Misdemeanor, pursuant to section 210.45 of the Penal Law of the State of New York. I declare that, subject to the penalties of perjury, any statements made on this application and any attachments are the truth and correct to the best of my knowledge. I hereby authorize the release of information regarding prior employment history/records, educational records, Law Enforcement Records, Driver’s License and Driving records, personal references and all like information bearing on my acceptance into the Pre-Employment Police Basic Training Course. This authorization shall be valid for a period of two (2) years from the date of signing of this document. A photocopy of this release will be as valid as an original thereof, even though the said photocopy does not contain an original writing of my signature. Signature ___________________________ Date _____________________

All statements are subject to verification

Genesee Community College

Campus Mandates, Policies, Reports, and Related Consumer Information Genesee Community College shall comply with all state and federal mandates. The vice president for student and enrollment services and the vice president for human resources and planning shall be responsible for the publication and dissemination of information related to such mandates, with the cooperation of the director of institutional research; the director of intercollegiate athletics; the senior campus security officer; and other Genesee Community College personnel as may be needed to provide timely and accurate information. Early in the fall of each year (or other such deadline as is established by legislation), Genesee Community College shall publish a document under the title, “Student Rights and Responsibilities Handbook.” This single document shall contain all information related to compliance with all legislation and any new amendments and similar compliance legislation enacted subsequent to the establishment of this policy. This document shall also be posted on the Genesee Community College website. Genesee Community College shall notify in writing every prospective student and employee of the College regarding the availability of this information in printed and electronic form, and shall, in the same notification, provide instruction on how copies of this information may be obtained. Genesee Community College shall electronically notify, every current student, faculty member, and staff member of the College of the availability of this information in printed and electronic form, and shall, in the same notification, provide instruction on how copies of this information may be obtained. Gender equity information shall also be made available on request to parents and coaches of high school athletes.

The “Student Rights and Responsibilities Handbook” contains information on a wide range of College policies and procedures (drug and alcohol abuse prevention, drug-free workplace, bias crimes, directory information, nondiscrimination, smoking, sexual assault, and sexual harassment), consumer information regarding student financial assistance and tuition liability, refund, and repayment of Title IV funds policies, and graduation and completion rates. Information regarding the Family Educational Rights and Privacy Act (FERPA) are included along with the most recent Cleary Act and Equity in Athletics Disclosure Act (EADA) reports. Additional information about Genesee Community College is available through numerous publications including, but not limited to, the College catalog and our website (www.genesee.edu).To request a copy of any Genesee Community College publication, please write or call: Genesee Community College Vice President for Student and Enrollment Services One College Road Batavia, NY 14020

(585) 345-6848

FREEAPPLICATIONFORADMISSIONComplete and mail this form and transcripts to: Genesee Community College, Admissions Office, 1 College Rd., Batavia, NY 14020

A PERSONALINFORMATION

1SocialSecurity#

2Name last first middle initial

3Birthname last first middle initial4Mailingaddress

street apartment # city state ZIP code

5Permanentaddresscheckhereifsameasmailingaddress

street apartment # city state ZIP code

6Countyofresidence

7Homephone# 8Cellphone#

9Emailaddress

10GenderMaleFemale 11Dateofbirth month day year 12AreyouacitizenoftheUnitedStates?YesNo

13AreyouHispanic/Latino?YesNoAIfHispanic/Latino,isyourbackground(SELECTONE):CentralAmericanDominicanMexicanPuertoRicanSouthAmericanOtherHispanic/Latino14Isyourrace(selectasmanyasapply):AmericanIndian/AlaskanNativeAsianBlackorAfricanAmericanNativeHawaiianorOtherPacificIslanderWhite

Your response to questions 13 and 14 is voluntary and confidential. Self-disclosure of racial or ethnic information will not be used to evaluate your application. Refusal to provide such information will not subject the applicant to any adverse treatment.

15CheckhereifyourparentisaGeneseeCommunityCollegegraduate.

16Haveyoubeenconvictedofafelonyorreceivedadisciplinarydismissalfromcollege?YesNo

If you have a learning disability or handicapping condition that may require accommodation, you may call our Center for Academic Progress at 585-345-6840 or write to: CAP, Genesee Community College, 1 College Road, Batavia, NY 14020-9704. Self-disclosure of disability information is solely voluntary. Such information will be kept confidential. Refusal to provide such information will not subject the applicant to any adverse treatment.

B ADMISSIONSINFORMATION

17Inwhichsemesterandyeardoyouwishtoenroll? FallSpringSummerYear

18Willyouenrollfull-timeorpart-time? Full-timePart-time You cannot enroll full-time in summer.

19CheckhereifyouplantoseekadegreeorcertificatefromGenesee. Students not seeking a degree or certificate are not eligible for financial aid.

06/12

CODEACTIVITIESHO HonorsProgram MB Men’sVarsityBasketball MG Men’sGolf ML Men’sLacrosse MS Men’sVarsitySoccer SG StudentGovernment SM Men’sSwimming SO Women’sVarsitySoftball SW Women’sSwimming TA Theatre WB Women’sVarsityBasketball WC Cheer/DanceTeam WG Women’sGolf WL Women’sLacrosse WS Women’sVarsitySoccer WV Women’sVarsityVolleyball

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B ADMISSIONSINFORMATION(CONTINUED)

20Ifyoucheckedtheboxin19,pleaseenterthecodeassociatedwiththeprogramthatyouwishtopursue. Refer to back page to see a list of programs or enter the code for “General Studies” if undecided.

21Ifmajorhasaconcentration,listcode. Refer to back page to see a list of concentrations.

22Ifyouanswered“Nursing”to20,areyoualicensedpracticalnurse?YesNo

23DoyouintendtoenrollinoneofGCC’sdistancelearningprograms?YesNoI’mnotsure Refer to back page for programs marked * - available online.

24Listthecodesforallactivitiesinwhichyouhaveparticipatedin. Refer to back page for a list of activities and codes.

25Incaseofemergency,notify:

Namelast first

26Emergencycontact’sphone#

Applicants must have an official high school transcript sent to the Admissions Office.GED recipients must send a copy of their equivalency scores.HIGHSCHOOLINFORMATION

27Inwhichmonthandyeardidyou(orwillyou)graduate? month year 28Whichtypeofhighschooldiplomadidyou(orwillyou)earn?Regents—AdvancedDesignationRegentsLocalIndividualizedEducation

HomeSchoolOutofStateGEDNone

29WhatisyourhighschoolCEEBcode? Gotohttp://www.suny.edu/Student/apply_tables_codes.cfm tofindyourhighschool’scode.-IfyouareaGEDrecipient,pleaseenter100100asyourhighschoolcode.-Ifyougraduatedfromanout-of-statehighschool,pleaseenter200200asyourhighschoolcode.-IfyourhighschoolislocatedoutsidetheU.S.,pleaseenter300300asyourhighschoolcode.-Ifyourhighschoolcodecannotbefound,pleaseenter400400asyourhighschoolcode.-Ifyouareahomeschooledstudent,pleaseenter500500asyourhighschoolcode.

Transfer students must have official college transcripts sent to the Admissions Office.COLLEGEINFORMATION

30WhatisyourcollegeFICEcode?Gotohttps://fafsa.ed.gov/FAFSA/app/schoolSearch?locale=en_ENtofindyourcollege’scode.

-IfyourcollegeislocatedoutsidetheU.S.,pleaseenter011000asyourcollegecode.-Ifyourcollegecodecannotbefound,pleaseenter010000asyourcollegecode.

ANSWERQUESTIONS31-34ONLYIFYOUARENOTACITIZENOFTHEUNITEDSTATES

31Countryofcitizenship

32AreyouapermanentUnitedStatesresident?YesNo

33Ifyouanswered“Yes”to32,whatisyouralienregistrationnumber?#A34Ifyouanswered“No”to32,indicateyourvisatype.B-2F-1H-4J-1A-2Other(specify)_________________________ Check F-1 if you need a student visa.

College Name

High School Name (if CEEB code is unknown)

By my signature below I attest that all information provided is accurate and complete.I understand that inaccurate or incomplete information may nullify my acceptance to Genesee Community College.

35APPLICANTSIGNATURE______________________________________________36DATE month day year

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If you are applying for admission into a restricted program, such as Nursing (including LPN to RN), Physical Therapist Asst., Respiratory Care, Paralegal, Veterinary Tech., Polysomnographic Tech., or Engineering Science, please be aware there are additional admissions requirements beyond completing an application.

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C ISTOBECOMPLETEDBYYOURHIGHSCHOOLCOUNSELORIFYOUAREAHIGHSCHOOLSTUDENT

37Schoolname

38Ifapplicable,provideabriefstatementregardinganymatterofinteresttotheAdmissionsCommittee.__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

39Student’sgraduationdate 40Student’sdiplomatype: Regents—AdvancedDesignationRegentsLocalIndividualizedEducation An Individualized Education diploma does not meet the requirement for admissions.

41Counselorsignature______________________________________________ 42Date month day year

WhatwillhappenafterIapply?Good question. But first, take a minute to make sure that you’ve filled out everything that you need to on the application form.

• Most importantly, don’t forget to sign and date your application.• Next, you may have noticed that the application is divided into sections A, B, and C. All applicants need to complete sections A and B. If you are a high school student, your counselor must fill out section C.• Did you pick a major (called a “program” in question 20)? The two-year degrees we offer are listed on the back.

Applicants must have an official high school transcript sent to our Admissions Office. If you hold a GED, you also must submit a copy of your equivalency scores. If you have not taken the ACT test, you must take Genesee Community College’s Compass placement test, which is free of charge. The placement test can be taken at any campus location. GCC almost always uses the Compass placement test or ACT test for placement purposes.

Whataboutfinancialaid?Roughly eight out of 10 full-time students at Genesee receive financial aid. In fact, the College awarded more than $26 million in aid in 2011. Here are three tips to get you started on the financial aid process:

• File a Free Application for Federal Student Aid (FAFSA). For the fastest turnaround time, file electronically at fafsa.ed.gov. If you’d prefer to file paper FAFSA, copies are available at our Financial Aid Office.• Next, follow through with the paperwork you’ll be sent after filing a FAFSA. You’ll receive a Student Aid Report (SAR), which will be sent automatically to our Financial Aid Office if you have listed Genesee’s SAR code (006782)on your FAFSA. If you are a New York state resident, then you also should receive information from the New York State Tuition Assistance Program (TAP) after your FAFSA is processed.• Finally, apply for scholarships. We offer many awards that help qualified students afford school. Check them out online at genesee. edu/scholarships or call the Financial Aid Office at 585-345-6900.

HowwillIknowwhattodonext?With few exceptions, Genesee is an open-admission institution. We notify in writing all applicants who have been accepted. However, if your application is incomplete, you’ll receive a checklist detailing what we need in order to move ahead. Sometimes we also call applicants to let them know about the status of their applications and to ask for documentation that we need. In the meantime, if you have any questions about the application process or would be interested in taking a tour of our campus or meeting some of the faculty, staff, and students, call our Admissions Office toll-free at 1-866-CALL-GCC (1-866-225-5422) or check our open house schedule online at genesee.edu/openhouse.

If you are under 21 and plan to enroll full-time, then your high school counselor must complete section C below and attach a final high school transcript to this application. If you are 21 or older or you do not plan to enroll full-time, then leave section C blank.

In accordance with federal regulations, the New York State Human Rights Law, Section 504 of the Rehabilitation Act of 1973, and the Americans With Disabilities Act, Genesee Community College does not discriminate on the basis of age, race, color, creed, gender, religion, marital status, veteran status, national origin, disability, or sexual orientation in educational programs, activities, admissions, or employment.

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CODEPROGRAMS/MAJORS/ CONCENTRATIONS Accounting730 -AAS 629 -AS 929 -CERT 726 AdministrativeAssistant(AAS) 260 Alcohol&SubstanceAbuseStudies(AS) 230 Biotechnology(AS) BusinessAdministration*732 -AAS *771 -AS 679 Communications&MediaArts(AS) 210 ComputerInformationSystems(AS) 990 ComputerRepair(CERTIFICATE) 505 ComputerSupport&Operations(AAS) 494 ComputerSystems&NetworkTechnologies(AAS) ComputerizedDrafting&Design 453 -AAS 953 -CERT CriminalJustice*640 -AAS*640P -Policing*640H -Homeland Security/Emergency Management*640C -Corrections Counseling*640F -Forensics*640G -General *240 -AS *920 -CERT 733 CustomerRelationshipManagement(AAS)904 DeafStudies(CERTIFICATE) 908 DevelopmentalDisabilitiesStudies(CERTIFICATE)500 DigitalArt(AAS) 906EarlyChildhood(CERTIFICATE) 242 EconomicCrimeInvestigation(AS) 530 EngineeringScience(AS) Entrepreneurship*734 -AAS *994 -CERT 220 EnvironmentalStudies(AS) 751 FashionMerchandisingManagement(AAS) 751D -Fashion Design 751M -Fashion Merchandising 205 FineArts(AS) 428 Fitness&RecreationSportsManagement(AAS)*985 GeneralEducation(CERTIFICATE) 905 Gerontology(CERTIFICATE) 907 HealthStudies(CERTIFICATE) 996 HelpDeskSupport(CERTIFICATE) 975 HospitalityManagement(CERTIFICATE) HumanServices605 -AAS650 -AS*250 LiberalArts&Science:GeneralStudies(AS)*201 LiberalArts&Science: Humanities&SocialScience(AA) *201E -English/Literature/Humanities *201S -Social Science *201F -Foreign Language *201H -History/Political Science

CODEACTIVITIESHO HonorsProgram MB Men’sVarsityBasketball MG Men’sGolf ML Men’sLacrosse MS Men’sVarsitySoccer SG StudentGovernment SM Men’sSwimming SO Women’sVarsitySoftball SW Women’sSwimming TA Theatre WB Women’sVarsityBasketball WC Cheer/DanceTeam WG Women’sGolf WL Women’sLacrosse WS Women’sVarsitySoccer WV Women’sVarsityVolleyball

CODEPROGRAMS/MAJORS/ CONCENTRATIONSCONTINUED

224 LiberalArts&Science:Math&Science(AS) 224G -General Math/Science 224C -Chemistry270 LiberalArts&Science:SportManagement(AS)*425 LiberalArts&Science:TeacherEducation(AS)720 MedicalAdministrativeAssistant(AAS) 927 MedicalOfficeAssistant(CERTIFICATE)987 MusicalTheatre(CERTIFICATE)621 Nursing(AAS) 937 OfficeAssistant(CERTIFICATE) 743 ParalegalStudies(AAS) 426 PhysicalEducationStudies(AS) 623 PhysicalTherapistAssistant(AAS) 647 PolysomnographicTechnology(AAS) 645 RespiratoryCare(AAS) *932 Sales&CustomerService(CERTIFICATE) TeachingAssistant470 -AAS470D -Developmental Disabilities470L -Learning Strategies and Technologies470G -Generalist *925 -CERT206 TheatreArts(AA) 461 TheatreTechnology(AAS) 738 Tourism&HospitalityManagement(AAS) 235 VeterinaryTechnology(AAS) WebDesign 493 -AAS 993 -CERT

*Also available online as a Distance Learning program