2021-2022 Buckeye Career Center Adult Education Application for Full-Time Program Admission
$50 non-refundable Application Fee Required.
* Required
Last Name
*
Your answer
First Name
*
Your answer
Middle Initial
Your answer
Maiden Name
Your answer
Street Address
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Your answer
Apt #
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
County
*
Your answer
Social Security Number (necessary to look up FAFSA info as well as other items)
Your answer
Date of Birth
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MM
/
DD
/
YYYY
Home Phone
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Your answer
Alternate Phone
Your answer
email address
*
Your answer
Gender
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Female
Male
Marital Status
*
Choose
Single
Married
Separated
Divorced
Widowed
Source of Income (Job, parents, spouse, etc.)
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Your answer
I plan to enroll in the ________________ program for the 2021-2022 school year.
*
Choose
Cosmetology
Dental Assisting
Heating, Ventilating, Air Conditioning, and Refrigeration
Heavy Equipment/CDL A Operator
Law Enforcement Training Academy
Medical Assisting (8am-3pm)
Medical Assisting (3pm-10pm)
Medical Office & Billing Specialist
Utility Lineworker
Welding Technology
What will your high school completion status be when you begin college in the 2021-2022 school year?
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High School Diploma
GED
Neither
High School Graduation Year or Date You Received GED
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Your answer
List the name/address of the school which you received your Diploma/GED:
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Your answer
List any schools you have attended since High School (School name, address, area of study, did you receive financial aid?):
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Your answer
How do you plan to pay for your tuition and book fees?
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Your answer
Have you ever been convicted of a crime?
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No
Yes
If yes, please explain.
Your answer
Highest school your father completed:
*
Choose
Jr. High
High School
College
Unknown
Highest school your mother completed:
*
Choose
Jr. High
High School
College
Unknown
How did you hear about Buckeye Career Center?
*
Choose
Newspaper Ad
Friend
College
Opportunities for Ohioans with Disabilities
Radio Ad
Co-Worker
Ohio Means Jobs
BCC Brochure
Relative
TAA
Other:
Student Certification (Please read and initial each line)
I certify the information given on this application is accurate to the best of my knowledge.
*
Your answer
I understand that all tuition & fees are due at the beginning of the program. If I am receiving financial aid, funds will come directly to the school to be applied to my account. Credit balances will result in a refund. If I am utilizing a payment plan, I will make the payments as arranged in the Enrollment Agreement.
*
Your answer
I agree to follow all Buckeye Career Center policies and procedures as stated in the student handbook.
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Your answer
I understand that I must maintain satisfactory progress in my chosen training program (minimum 90% cumulative attendance and 2.0 grade point average- might be superseded by individual program requirements).
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Your answer
I understand that should I withdraw (or be dismissed from) a training program, I will be responsible for all tuition & fees based on Buckeye Career Center's refund policy. (Policy located in student handbook)
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Your answer
I understand that failure to maintain satisfactory academic progress will result in probation or dismissal from my training program and loss of financial aid. Anytime financial aid is lost, it might increase the amount I must pay.
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Your answer
I realize Buckeye Career Center is required to share my educational progress information with any agency which may be providing financial assistance. I authorize the sharing of my educational progress information.
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Your answer
I authorize Buckeye Career Center to share my educational progress information with prospective employers.
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Your answer
I will share any sources of financial aid with the Financial Aid Administrator within 10 days of notification.
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Your answer
I do hereby attest that the information provided above are true statements and realize that any false information is grounds for immediate dismissal. Print name and date.
*
Your answer
Buckeye Career Center conforms to all federal, state, and local laws and regulations including Title IX and nondiscrimination against any student because of race, color, creed, sex, religion, citizenship, economic status, marital status, pregnancy, handicap disability, age, or national origin. This policy of nondiscrimination shall also apply to otherwise qualified handicapped individuals.
Financial Aid
Leave blank if not applying for financial aid. Buckeye Career Center only processes Pell grants and does not process federal loans (Stafford loans, Direct loans, Parent Plus loans, etc).
Have you completed your FAFSA (
https://studentaid.gov/
)? Buckeye Career Center School Code: 030659.
*
Yes
No
Not Completing FAFSA
Do you need help completing the FAFSA?
Yes
No
Not Completing FAFSA
Clear selection
Will you have other financial aid? Check all that apply.
Ohio Means Jobs
Opportunities for Ohioans with Disabilities
TAA
Scholarship
Veteran's Assistance (GI Bill)
Other:
If yes to scholarship, where is it from?
Your answer
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