Adult Admissions Application
Salem County Vocational and Technical Schools
PO Box 350
Woodstown, NJ 08098
856-769-0101 x 5371
Personal Information
*
First Name
*
Last Name
*
Middle Initial
Maiden
*
Email Address
*
Phone
*
Address 1
Address 2
*
City
*
State
*
Postal Code
*
Is English your native language?
Yes
No
*
Program Applying For
CNA or other Health Care Program
Cosmetology September 2012
Cosmetology State Board Preparation/Refresher Course Summer 2012
*
Date of Birth (mm-dd-yyyy)
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Sex
Male
Female
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SS#
*
Hispanic/Latino
Yes
No
*
Ethnic Background
White (Non Hispanic)
Natice Hawaiian/Pacific Islander
American Indian/Alaska Native
Black
Asian
Other
Two or more races
*
Are you legally a United States citizen?
Yes
No
If no, country of citizenship.
Background Information concerning age, sex, SS#, ethnic background etc. are for federal/state reporting purposes only. It does not affect admission or placement at the school.
Educational Background
Name of High School Attended
Year Degree Earned
Place
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Degree
High School Diploma
GED
None
*
Indicates Response Required