CSEMS Application

*SID:

Last High School/GED Center Attended:

School:

Year:

State:

Cumulative GPA:

Previous College Attended:

Please check the appropriate response:

Eligibility is based on the following. Are you a:

If you are currently enrolled, please indicate whether you are enrolled Part-Time or Full-Time?

I am currently enrolled at GRCC as a:

Do you plan to earn a:

Program of Study:

Anticipated GRCC Graduation:

Do you expect to be employed while attending school?

If yes, what number of hours do you expect to work per week?

Do you have a paid or unpaid internship?

Race:

Ethnicity:

Disability Status:

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