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? *

Program Applying For *

Date of Birth (mm-dd-yyyy) *

Sex *

SS# *

Hispanic/Latino *

Ethnic Background *

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.

Name of High School Attended

Year Degree Earned

Place

Degree *

High School Diploma	GED
None