Chesapeake College Admissions Application

FOR OFFICIAL USE ONLY

P.O. Box 8, Wye Mills, MD 21679

Web address: www.chesapeake.edu
(410) 822-5400; 758-1537; 228-4360 Fax #: 410-827-5878
TTY Users: Call via Maryland Relay

Date: ________ Semester: _________

Stud. ID #: ______________________

Please print clearly. Use black or blue ink. Check the appropriate boxes and complete entire application. No application fee is
required. Please return completed application to: Chesapeake College, Office of Admissions, P.O. Box 8, Wye Mills, MD 21679.

PERSONAL INFORMATION
Social Security numbers are used by the College to ensure the integrity of
student records and to meet federal government reporting requirements. They
are also needed for Scholarships and Financial Aid.

Social Security
Number:
Last Name (Legal):

First Name:

Other Names (i.e. maiden):

Full Middle Name:

Date of Birth:
(month/day/year)

Current Address
Street Number and Name/Apt. # :______________________________________________________________________________________________ P.O. Box #: __________________________________
City:
How long have you lived at your current address?

State:

Zip Code:

Less than 3 months

3 months or more

If less than 3 months, list previous address:

Street Number and Name/Apt. # :___________________________________________________________________________________ P.O. Box #: __________________________________
City:
Length of time at previous address:

State:
Months:

Zip Code:
Years:

County of Residence:

Phone Numbers:

005 Caroline

017 Queen Annes

Other MD County (write below):

009 Dorchester

020 Talbot

___________________________

014 Kent

040 Out-of-State

099 Out-of-Country

Home:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

Cell:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

Email:_____________________________________________________________________________________________________________________________________________
I certify that the following information is correct and complete to the best of my knowledge:
I am a dependent of and live with my parent(s) or guardian(s) at the Current Address given above.
I was claimed by my parents in the previous tax year.

Yes

If yes, what is their legal state of residence? _____________________________________

Gender:

Male

Yes

No

No
If Maryland, what county? ______________________________________

Female

How many hours do you spend in a typical 7-day week:

Working for pay:

None

1-5 hours

6-10 hours

Providing care for dependents living with you:

None

11-20 hours
1-5 hours

21-30 hours
6-10 hours

More than 30 hours

11-20 hours

21-30 hours

More than 30 hours

ETHNICITY INFORMATION
The following information is gathered for purposes of meeting state and federal agency requirements. This information is not used for admission to
Chesapeake College.
Part 1: Please select the group which most closely represents you:
Hispanic/Latino (HIS)
Part 2: Please select one or more of the following groups which most closely represents you:
American Indian or Alaska Native (AN)
Asian (AS)
Black or African American (BL)
Native Hawaiian or Other Pacific Islander (HP)
White (WH)

Non-Hispanic/Latino (NHS)

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MILITARY STATUS
Are you a veteran or a dependant (including spouse) of a veteran?

Yes

If yes, check one:

Veteran

Dependant

If you are active duty military, where are you stationed? ________________________________________________________________________ (To be considered for incounty or in-state tuition due to BRAC, you will need to provide your orders to the Registration office at the Wye Mills Campus for verification.)

CITIZENSHIP INFORMATION
CITIZENSHIP

(Please check one option)

U.S. Citizen (US)

Permanent Resident (RA)

(The applicant must present the Permanent Resident Card to the Admissions Office staff at the Wye Mills Campus for

verification prior to college acceptance.) A copy of the Card will be made and included with this admissions application. In the absence of documentation, a
student is charged out-of-state tuition and fees.
Non-U.S. Citizen (NA) (If you checked Non-U.S. Citizen, you must state your country of citizenship here: ___________________________________________)
Are you here on a VISA?
Yes
No
If yes, state type of VISA: ________________________________________________
VISA #: ______________________________________________________________________________________________
To all VISA Holders: You must submit your original documentation to the Admissions Office at the Wye Mills campus for verification prior to college
acceptance.
Country of Citizenship: _______________________________________________________
Do you plan to enroll at Chesapeake College as a visiting student and maintain an F1 status at your home school?

Yes

No

All VISA students must contact the Registrar at Chesapeake College for admission and enrollment information and procedures.
Application deadlines for International Students:

June 1 for the Fall semester

November 1 for the Spring semester

PERSONS TO CONTACT IN CASE OF EMERGENCY

Last Name:
Relationship to you:

First Name:
Parent/Guardian

Spouse

Last Name:
Relationship to you:

Middle Initial:
Phone Number: ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

Other
First Name:

Parent/Guardian

Spouse

Middle Initial:
Phone Number: ___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

Other

FIRST-GENERATION STUDENT INFORMATION

Your parents educational level:
Less than high school
Completed high school or GED
Some college, but no degree
Two-year college degree
Four-year college degree
Advanced degree (Graduate or Professional)
Unknown
Semester/Year applied for:

Mother

SEMESTER START STATUS

Fall (Aug.-Dec.)

Are you applying for Financial Aid?

Father

Spring (Jan.-May)

Yes

Summer (June-Aug.)

Year 20__ __

No

Academic Goal

Admission Status: (check one)

(FF) First-time Freshman (never attended a college/university after

Please check the one statement which most closely corresponds to your primary reason for
attending Chesapeake College:

high school)
(HS) High School (attending while still enrolled in high school)
(ND) Non-Degree seeking (taking courses WITHOUT intention
of earning a Chesapeake College degree)
(R3) Returning Student (returning to Chesapeake after absence of
three semesters or longer)
(RT) Returning Student (returning to Chesapeake after absence of
less than three semesters)
(TR) Transfer (transferring from another college to Chesapeake)

1). Exploration of new career or academic area

2). Preparation for immediate entry into a career
3). Preparation for transfer to a four-year institution
4). Preparation for a job I currently hold
5). For interest and self-enrichment
6). Visiting student

(VS) Visiting Student (enrolled at another college and planning to

transfer Chesapeake College coursework back to home institution)

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SECONDARY SCHOOL INFORMATION

From which high school did you graduate or will you graduate?

Year of graduation: ____________

210318 Cambridge-South Dorchester

210994 Kent Island

210469 Wesleyan Christian School

210491 Chesapeake Christian School

210477 North Caroline

219300 Out-of-State High School

210525 Colonel Richardson

210655 North Dorchester

210490 Easton

210364 Queen Annes County

219501 Home-Schooled

210496 Sts. Peter & Paul

211095 Kent County

210925 St. Michaels

219100 Other Maryland School

Please list: _____________________

Did you graduate from a local high school CTE (Career and Technology Education) Program?

Yes

No

GED Students: Please complete the following section.

219200 Maryland GED

Year earned: _______________

219400 Out-of-State GED

Year earned: _______________

I am interested in attending Chesapeake College, but have not graduated from a high school nor earned a GED.
(Note: Applicants who checked the box above will not be denied admission to Chesapeake College.)

COLLEGE OR UNIVERSITY ATTENDANCE

I have earned college credit at other colleges or universities since high school graduation.

Yes

If yes, what is the highest degree you have earned?

Masters

Associates

Bachelors

No
Doctorate

PRIOR COLLEGES/UNIVERSITIES ATTENDED (Please list all institutions starting with the most recent. Use separate sheet if necessary.)
NAME

CITY AND STATE OR COUNTRY

DATES ATTENDED

DEGREE

________________________________________________________

________________________________________

_______________________

___________

________________________________________________________

________________________________________

_______________________

___________

________________________________________________________

________________________________________

_______________________

___________

BACHELORS DEGREE PROGRAMS EASTERN SHORE HIGHER EDUCATION CENTER

Salisbury University and University of Maryland - University College offer the junior and senior years of the following Bachelors Degree Programs at the
Higher Education Center located on the Wye Mills Campus. If you intend to complete your Bachelors Degree at the Higher Education Center, please
check the appropriate intended degree program box.
Salisbury University
Social Work

Elementary Education

University of Maryland - University College

Business Administration
Criminal Justice

AREA OF STUDY - PROGRAM/MAJOR CODE

It is important that you complete this section to ensure a correct selection of your College Major Code. Please turn to the back page of
this application and write in your three-digit Program/Major Code. ____ ____ ____
Note: Chesapeake College reserves the right to award students all academic credentials earned, including certificates and degrees.

HONOR CODE FOR CHESAPEAKE COLLEGE

Students of Chesapeake College agree to demonstrate academic and personal integrity. Chesapeake College students are persons of integrity: they stand for that which is right.
They tell the truth and ensure that the full necessary truth is known. They do not lie. * They embrace fairness in all actions. They ensure that work submitted as their own is
their own, and that assistance received from any source is authorized and properly documented. They do not cheat. * They respect the material and mental property of others
and ensure that others are able to benefit from the use of their own property. They do not steal. * Therefore, each student at Chesapeake College pledges to:
Submit assignments that reflect his/her own thoughts and work
Cite and properly acknowledge the thoughts and work of others
Complete all test and other in-class assignments using his/her own thoughts
Reject the use of materials acquired illegally
Respect the rights and property of others
Those found to be in violation of this code agree to disciplinary sanctions and appeal processes outlined within the Chesapeake College Student Code of Conduct.
* Adapted from the U.S. Naval Academy Code of Honor

APPLICANTS AGREEMENT (Please read carefully and sign)

In making this application, I accept and agree to abide by the policies and regulations of Chesapeake College. I certify that the information on this application is complete and
accurate. Failure to provide accurate information, particularly in the case of residency, may be just cause for dismissal from the college. I understand that it is my responsibility
to notify the Office of Registration of any change in the information contained in this application.

Applicant Signature: _________________________________________________________________________________________________ Date: _______________________________________

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AREA OF STUDY - PROGRAM/MAJOR CODE

Please circle ONE Program/Major Code in the section below and write in your three-digit program in the AREA OF
STUDY - PROGRAM/MAJOR CODE section on page 3. Detailed information about programs of study, including course
requirements and course descriptions, can be found in the online College catalog at www.chesapeake.edu.
Any Program/Major marked with an asterisk (*)is not eligible for Financial Aid.
Accounting/Business
Education/Teaching (continued)
Human Services
Accounting (410) A.A.S.
Advanced (412) Certificate
Basic (411) Certificate
Tax (413) LoR*
Business Administration (350) A.A.
Business Management Tech. (401) A.A.S.
Business Management Tech. (402) Certificate
Business Management Tech. (403) LoR*

Secondary Education-English (310) A.A.T.

Secondary Education-Mathematics (307) A.A.T.
Secondary Education-Physics (308) A.A.T.
Teacher Aide (345) Certificate

Mental Health (682) A.A.S.

Substance Abuse/Addiction (683) A.A.S.

Liberal Arts and Sciences

Health, Fitness & Exercise Science

Exercise Science (151) A.A.
Exercise Science (158) Basic Certificate*
Exercise Science (159) Advanced Certificate*
Exercise Science/Allied Health (155) A.A.
Sports Management (160) A.A.
Sports Management (168) Basic Certificate*
Sports Management (169) Advanced Certificate*

Agriculture & Environmental Studies

Landscape Architecture (390) A.S.
Landscape Management (395) A.S.

Computer Studies
Computer Information Security (495) A.A.S.
Computer Information Systems:
Interactive Media/Web Design (474) A.A.S.
Advanced (491) Certificate
Basic (492) Certificate
Interactive Media/Web Design (453) LoR*
Microcomputer Applications Specialist (486) A.A.S.
Advanced (496) Certificate
Basic (497) Certificate
Micro. Applications Specialist (455) LoR*
PC & Network Management (477) A.A.S.
Advanced (478) Certificate
Basic (479) Certificate*

Criminal Justice

Engineering Technology
Drafting and Design (743) A.A.S.
Drafting and Design (742) Certificate
Drafting and Design (745) LoR*
Welding
Advanced (776) Certificate
Basic (775) Certificate
Welding (763) LoR*

Paralegal Professions
Paralegal Studies (620) A.A.S.
Paralegal Studies (622) Certificate

Technical/Professional Studies
Technical/Professional Studies (400) A.A.S.

Environmental Science

Undeclared Majors or Transfer

Certificates (150 and 250)*

Environmental Science (360) A.S.

Environmental Monitoring (364) Certificate
Land Use Management (405) LoR*

(Students in an undeclared major or

transfer certificate are NOT eligible for
financial aid.)

Health Professions

Corrections (604) A.A.S.

Corrections (608) Certificate
Crime Scene Technician (607) A.A.S.
Crime Scene Technician (605) Certificate
Law Enforcement (602) A.A.S.
Law Enforcement (606) Certificate

Education/Teaching
Early Childhood Development (641) A.A.S.
Advanced (642) Certificate
Basic (645) Certificate
Early Childhood Development (643) LoR*
Early Childhood Education/Early
Childhood Special Education (309) A.A.T.
Elementary Education/Elementary
Special Education (305) A.A.T.
Secondary Education-Chemistry (306) A.A.T.

Cardiac Rescue (525) Certificate*

Emergency Medical Services (518) A.A.S.
Emergency Medical Services (519) Certificate
Nationally Registered Paramedic (516) Certificate
General College Studies: Allied Health (120) A.A.
Nursing: Registered Nurse (131) A.S.
Phlebotomy (515) LoR*
Physical Therapist Assistant (140) A.A.S.
Radiologic Sciences (502) A.A.S.
Surgical Technology (512) Certificate

Non-Degree Seeking Students*

Hotel/Restaurant Management

A.A.S. Associate of Applied Science

A.A.
Associate of Arts
A.S.
Associate of Science
A.A.T. Associate of Arts in Teaching
Other Award Abbreviation
LoR
Letter of Recognition *

Hotel/Restaurant Management (650) A.A.S.

Food Service Management (655) Certificate
Food Service Management (654) LoR*
Hotel/Resort Management (651) Certificate
Hospitality Management (648) LoR*

Date application entered: _____________________________

FOR OFFICIAL USE ONLY

New Application ______

If updated, last semester attended: ____________________

Updated Application ______

Liberal Arts and Sciences (200) A.A.

African-American Studies (820) LoR*
Biology (311) LoR*
Basic Chemistry (312) LoR*
Communications (313) LoR*
General Science (314) LoR*
Geography (315) LoR*
Mathematics (316) LoR*
Music (803) LoR*
Transfer Studies
Advanced (250) Certificate*
Basic (150) Certificate*

Processed by: _______________________________________________ at (please check one)

___WMC

___ Cambridge Ctr.

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Audit (950)*
Personal enrichment/Professional
development/update job skills (951)

Dual Enrollment Students (960)*

The 960 option is for high school
students who plan to enroll in the Dual
Enrollment Program.)
Key to Degree Award
Abbreviations

___ Center for Allied Health

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