First Name (required) Middle Name Last Name (required) Student ID # SSN Date of Birth (required) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006 High School (required) Projected High School Graduation Date (required) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2018201920202021202220232024 Plan/Major at WCC What term will you begin classes after high school? Semester (required) Summer (May) Fall (August) Spring (January) Year (required) - Select -2020202120222023 Cell/text number Home phone number Email address (required) Mailing AddressPO Box or Street (required) City (required) State (required) - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code (required) Please note by submitting this form you are acknowledging that it is your responsibility to request an official mid-year high school transcript after your first semester grades have posted if you are applying for a selective admission health program at WCC. This transcript must be received by the February 15th deadline to apply for admission to a health program for the following fall. All high school students must submit official high school transcripts that reflect final grades and a high school graduation date. If you have taken the SAT or ACT, you must request your scores from www.collegeboard.org. Test score reports must be official and cannot be accepted from any other source.