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Cerritos College Adult Education & Diversity Programs Application (OWL)
Each student applying for a Cerritos College Student ID number needs their OWN personal email address.
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* Indicates required question
Which semester are you applying for the year 2023?
*
Choose
Spring (January 11th - May 21st )
Summer (May 24th - August 13th)
Fall (August 16th - December 17th)
1. Last Name
*
Type your last name
Your answer
First Name
*
Type your first name
Your answer
Middle Name
Type your middle name or initial if you have one.
Your answer
2. Marital Status
*
Choose
Single
Married
Divorced
Widowed
Separated
3. Social Security Number
If applicable
Your answer
4. Gender
*
Male
Female
Non-Binary
5. Date of birth
*
MM/DD/YYYY
MM
/
DD
/
YYYY
6. Age
Your answer
7. Have you ever attended Cerritos College?
*
Yes
No
If yes to number #7, please add your seven digit Cerritos College student ID number.
Your answer
8. Citizenship
*
U.S. Citizen
Permanent Resident
Amnesty Recipient
Refugee
Student Visa
Other, not a U.S. Citizen, hold other Visa
Residency Location
*
Where have you resided for the past 24 months? Please list your City and State.
Your answer
Residency Dates
*
Please list the dates you have resided at the above location? (MM/DD/YYYY to MM/DD/YYYY)
Your answer
9. Ethnic background
*
Choose
Chinese
Asian: India
Japanese
Korean
Laotian
Cambodian
Vietnamese
Other Asian
Black/African American
Filipino
Hispanic
Mexican
Central American
South American
Other Hispanic
American Indian/Alaskan
Guamanian
Hawaiian
Samoan
Other Pacific Islander
White
10. Phone Number
xxx-xxx-xxxx
Your answer
11. Home Address (No PO Boxes)
*
Your answer
12. Mailing Address, if different from above (PO Box okay)
Your answer
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