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Adult Education Admissions Application
Salem County Vocational and Technical Schools
Operating on Salem Community College Campus
460 Hollywood Ave
Carney's Point, NJ 08069
856-351-2933
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
*
Welding - Level 1 (75 Hour - In Person)
Introduction to Automotive Service and Repair
CPR (10 Hour - In Person)
Certified Medical Assistant (200 Hour - Hybrid)
Phlebotomy (45 Hour - Hybrid)
Certified Nurse Aide (90 Hour - In Person)
Serv Safe (10 Hour - Hybrid)
Real Estate (75 hour - Online) Pre-License Salesperson
Pharmacy Technician (125 Hours - Online)
Intro to Basic Electrical Technology - (45 Hours - In Person)
Basic Welding (75 Hour - In Person)
Automotive (150 Hour - In Person)
Date of Birth (mm-dd-yyyy)
*
Sex
*
Male
Female
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
Degree
*
High School Diploma
GED
None