Project AIM APPLICATION

Semester / Year:

New Project AIM Applicant Former Project AIM Student

 IDENTIFYING DATA

First Name: Middle Initial:
Last Name:

MAILING ADDRESS:
P. O. Box Village:
Guam, Zip:

STREET ADDRESS:
Village:
Guam, Zip:

CONTACT NUMBERS:
Home: Work:
Cell or Pager:   E-mail Address:

ETHNIC ORIGIN: Chamorro Filipino Chuukese Pohnpean Marshallese Palauan Yapese Kosraean White, Not Hispanic Chinese Korean Japanese Vietnamese Hispanic American Indian Black, Not Hispanic Other (Choose one)

DATE OF BIRTH: Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year   

SEX: Male Female

MARITAL STATUS: Married Single Divorced

MILITARY VETERAN: No Yes  What branch of Service?

CITIZENSHIP: United States Legal Resident
                        Other (specify)

PARENT'S COLLEGE ATTENDANCE:
Did either of your parents earn a Bachelor's Degree
from a four year university?            No Yes

 HEALTH & DISABILITY

Do you have a disability?:    No Yes

Documentation on file in our office?      No Yes

What type of special accommodation do you need?

 FINANCIAL STATUS

Number of people living in your household
that are claimed on your income tax:                

Are you head of household?                              No Yes

Annual household income that is claimed
on your last income tax form after deductions:       

Source of Income:

Are you currently receiving financial aid?          

If you are receiving financial aid then check the appropriate box.

 EMPLOYMENT

Are you currently working? No Yes  

Employer's Name:

Employer's Address:
Village:
Guam,  Zip:

Work Telephone #: 

How many hours per week do you work?

Job Title:
 

 EDUCATION

Former High School:

Other Educational Certificates or Degrees:

GED Adult High School AS/AA Degree Certificate
Four Year College (location:)

Do you plan to transfer to a 4-year college or university? No Yes

Declared major at GCC?    

 AS / AS Degree Certificate

How many credits have you earned at GCC to date?

Will you transfer credits from another institution?     No Yes

What is your current Cumulative Grade Point Average?

Upon submission of this electronic application the information I have
given is correct and accurate to the best of my knowledge.  I understand
that intentional falsification of any information of this application can
disqualify me from participation in the program.  Furthermore, I understand that
program staff will monitor my academic status through access of my
student records and will maintain confidentiality of my student records.