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Instructions

Fill out the following form completely. When complete, click the "Submit Application" button to send it to the Admissions Office at Allegany College of Maryland.

Personal Information

Social Security Number: *

Name: First: *   MI:   Last: * Maiden:

E-Mail Address:

Marital Status (for Statistical Purposes Only)
Single     Divorced
Married     Widowed

Permanent address and phone, including area code. (if under 16, give parent or legal guardian):

Address  *
City        *,  *  Zip code  *

Home phone:   Work phone:

Local address and phone (if different from permanent):

Address  *
City        *,    Zip code  *

Home phone:  

Date of birth:

Sex: Female   Male

Citizenship Status:
U. S. Citizen
Resident Alien
Asylee
Refugee
Other, please explain:

I am applying for veterans' benefits.

Check all of the following activities which you would be interested in participating at Allegany College of Maryland:

Honor program
        (B+ avg. req)		 Peer Tutor Soccer Volley Ball
Student Government Tennis Women's Basketball

Race: (for statistical purposes only) 

Have you ever been charged with, indicted for, pleaded guilty / no contest to, or found guilty of any criminal offense excluding minor traffic violations? YES     NO

If yes, please give us an explanation.


Educational Background

Education completed at time of entrance to Allegany College of Maryland:*

High School Graduate
I plan to attend college while also attending High School
GED Recipient
Do not hold HS diploma or GED
College

Have you previously applied for admission to Allegany College of Maryland? (YES or NO)

Year graduated or expected to graduate from high school or obtained GED:

High school from which you graduated:

Name of HS: City:  

List below each accredited college or university you have attended since high school, including Allegany College of Maryland. (Please list most recent first)
Name of College or University / State Degree Earned / Year # of Credits Earned (if degree not attained)

Has disciplinary action been initiated or taken against you at any of the institutions attended?
YES     NO

If yes, please give us an explanation.

Educational Goals

Select your program of study while attending Allegany College of Maryland:  *


Do you plan to attend: (select one)
Cumberland Campus
Bedford County Campus
Somerset County Campus
Cumberland & Bedford
Cumberland & Somerset


(PLEASE CHECK ONE)
I plan to begin my studies at Allegany College of Maryland

Fall Spring Summer    


Check the one statement which most closely corresponds to your
primary reason for attending Allegany College of Maryland:
Exploration of new career or academic areas
Preparation for immediate entry into a career
Preparation for transfer to a four-year institution
Update skills for a job currently held
Interest and self-enrichment
Other:

Please indicate how you heard about Allegany College of Maryland:

Recruiter HS Guidance Counselor Newspaper TV
Radio Publications Website Other


I have read the statements contained herein and accept the conditions and policies. Further, I certify that all information provided in this application is true/accurate and that any omissions or inaccuracies could result in dismissal from the College.

I understand that it is my responsibility to notify the Admissions Office of any change in the information contained on this application.

I am a legal resident of * (county)  * (state) and have resided there for * (length of time) immediately preceding the first day of classes of the semester applied for at Allegany College of Maryland. Further, my presence during this period was not for the purpose of temporary residence incident to enrollment in an institution of higher education. (Documentation of residency may be requested).

Please Click Here to read Pertinent College Information

In making this application, I agree to abide by all College rules, policies, and regulations, as well as local, state, and federal laws. I further accept and agree to abide by the policies and regulations of Allegany College of Maryland concerning drug and alcohol abuse and understand that the unlawful use of drugs or alcohol will subject me to penalties contained in those policies and regulations.

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12401 Willowbrook Road, SE · Cumberland, MD 21502-2596 · 301-784-5005
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