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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
*
-
Culinary Arts/Food Preparation/ Food Service
Basic Welding
Office Manager/Administrative Assistant
Microsoft Office Specialist Outside Tester
Basic Life Support (CPR)
Patient Care Technician Program
CNA Program
CHHHA Program
Medical Assistant Program
Phlebotomy Program
Cosmetology 2015-2016
Cosmetology 2016-2017
Cosmetology 2017-2018
Cosmetology 2018-2019
Cosmetology State Board Preparation/Refresher Course
Cosmetology Teacher
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