CAR Building | First Floor, Suite 105 | 765 Newman Springs Road | Lincroft, NJ 07738Telephone: (732) 224-2510 | Fax: (732) 224-1969

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OKDALE COMMUNITY COLLEG

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BROOKDALE COMMUNITY COLLEGEEOF ADMISSIONS APPLICATION

I. BIOGRAPHICAL INFORMATION: Please print information clearly.

SOCIAL SECURITY #: _________________________________________ BROOKDALE ID#: ________________________________________

LAST NAME: ________________________________________ FIRST NAME: _______________________________________M.I. ________

ADDRESS: ______________________________________CITY: ______________________________ STATE: ______ ZIP: _______________

TELEPHONE:_____________________________________________ CELL PHONE: ______________________________________________

E-MAIL: ___________________________________________________ DATE OF BIRTH: ________/________/________ (MM/DD/YYYY)

II. DEMOGRAPHIC INFORMATION

I IDENTIFY MY GENDER AS: _________________________________________________________________________________________

MARITAL STATUS: __________ SINGLE __________ MARRIED __________SEPARATED__________ WIDOWED__________DIVORCED

RACE/ETHNICITY, PLEASE SELF-IDENTIFY: ______________________________________________________________________________

CITIZENSHIP AND RESIDENCY STATUS: _____________________ U.S CITIZEN_____________________PERMANENT RESIDENT

IF PERMANENT RESIDENT, PROVIDE ALIEN REGISTRATION # _______________________________________________________________

HAVE YOU LIVED IN NEW JERSEY FOR A MINIMUM OF 12 CONSECUTIVE MONTHS? ____ YES _____ NO

ARE YOU AN UNDOCUMENTED NJ DREAMER (DACA) ____ YES _____ NO

ENROLLMENT STATUS: Check one of the following to note your entrance status.

o First-Time College Student – High School Senior/Graduate

o First-Time College Student – Recipient of GED/High School Equivalency Diploma

o EOF Transfer Student- Enrolled in an EOF program at another college/university

o Transfer Student – Never enrolled in EOF/EOP program at another college/university

o Current Brookdale Student – Never enrolled in EOF/EOP program at another college/university

PLEASE PROVIDE FULL NAME, AGE, AND RELATIONSHIP TO YOU FOR EACH HOUSEHOLD MEMBER BELOW:

FIRST NAME LAST NAME AGE RELATIONSHIP TO APPLICANT

PERSONAL STATEMENTNOTE: Complete the personal statement only if:

a) your current high school GPA/average is below 2.30/77/C+ (based on a 4.00 scale)

b) your current college/university GPA is below 2.50

c) you earned a GED/High School Equivalency Diploma. Please answer in essay form (minimum: 250 words). You may elect to attach a typewritten statement.

ESSAY: Everyone has a life story. What are some aspects of yours, and how have your personal experiences influenced your academic and career goals?

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ENROLLMENT TERM: ¨FALL 2020 ¨ SPRING 2021