ࡱ> Y[X 7bjbj BQ'ppppp8,('''''''$)q,r'p"'pp''   Rpp' '  %h&[3?vD&''0(T&X,, &,p& ''C(, 6: NEW MEXICO TECH COMMUNITY COLLEGE APPLICATION FOR ADMISSION OR READMISSION*  I am applying for: ___Fall ___Spring ___Summer Year 20___ Office Use Only Have you taken classes at ɫ Tech? ____ Yes ____No _____ Adm. _____ Read. Do you have a bachelor degree? ____ Yes ____No ____UG _____ GR Please print ______________________ ______________________ _________________________ Name (Last) (First) Student ID # or SSN _________________________ ____________________________________ __________________________________ Phone Number NMT E-mail Address Non-NMT email address Are you a ɫ Resident ______Yes ______No Date of Birth: _________________ Mailing Addres________________________________________City:__________________ State: ______ Zip Code: ________ Have you ever been convicted of a crime that could have resulted in one year or more of prison time (following a jury or bench trial, a guilty plea, or a nolo contendere pleas), been charged with such a criminal offense that was later dismissed as a result of a plea bargain or alternative sentencing arrangement, or are such criminal charges pending or expected to be brought against you? You are under continuing obligation to immediately update your response to this question if your circumstances change after you submit this application. Yes________________ No______________ If yes, for each crime you must provide a detailed explanation and copies of all official records related to your case. Include state, location, crime, dates, and case number. If applicable, provide the name and phone number of your parole or probation officer. Finally, by submitting your readmission application, you are giving NMTs representatives authority to investigate your record and giving legal authorities permission to discuss your case with NMTs representatives. Pick one: _____ I have attend another college or university. a) Are you planning to take courses other than Community education or Physical recreation? ______Yes ______No (If yes: Please provide an unofficial transcript from the school you attended) _____ I did not attend another college or university. Did you leave on academic suspension or probation? ______Yes ________No (If yes then you are limited to PR/ FA/ CED courses; ASAC readmission is required for academic courses) I certify that all information given in this application is complete and accurate. If I am accepted as a student at ɫ Institute of Mining and Technology (ɫ Tech), I agree to conform and abide by all rules, regulations, and procedures of the Institute. Misrepresentation in any statement by me will be considered adequate grounds for denial of admission, for cancellation of registration, or dismissal from the Institute. __________________________________________________________ _______________________ Signature Date ___________________________________________________________ Print Name *This applies only to non-degree-seeking, non-credit, and special case students. 12/6/2019 Continued on back NEW MEXICO TECH Community Registration CRN -Course Ref. NumSubjectCourse NumberSectionCredit HoursCourse TitlesDaysTime                                                                         Total Hours________ Signature required to complete registration. 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