Moraine Valley Community College
Criminal Justice Education-Training Partnership
Application for Admission
Illinois Department of Corrections (IDOC)

• Class No. _________ , check one of the following:
  [__] Basic Corrections Officer
  [__] In-Service, Austin High School
  [__] Specialized Training, Title: ________________________________

Name _____________________________ SSN _____________________
Address _________________________     City________________________
State ____    ZIP Code _________              Female ___ Male ___ 
Date of Birth ___ / ___ / ___          U.S. Citizen  Yes __ No __ 
                                                          If No, What Type of Visa? _____

Admission Semester: [__] Fall 20__ semester [__] Spring 20__ semester [__] Summer 20__ semester Enrollment Status: [__] Full-Time Student  (12 credits or more) [__] Part-time student (less than 12 credits) Area of Interest:  1260 Student Classifications: [__] Degree Seeking [__] Non-Degree Primary Goal of Attending Moraine: [__] Prepare for transfer to 4-year college [__] Improve skills for my present job [__] Prepare for an immediate job Educational Objective: [__] Complete one or several courses (not pursue degree/certificate) [__] To complete a certificate [__] To complete an associate's degree Do You Plan to Transfer to a 4-Year College? [__] Yes     [__] No Ethnic Origin (Statistical purposes only): [__] Asian or Pacific Islander [__] Native American Indian [__] African American (Black) [__] Hispanic or Latino [__] Caucasian (White) [__] Nonresident Alien [__] Refuse to indicate

Highest Degree Previously Earned [__] GED                      [__] High school diploma [__] Some College      [__] Certificate [__] Assoc. Degree    [__] Bachelor's degree [__] Master's degree  [__] Professional degree [__] Doctoral degree  [__] Other [__] None Final High School transcript/official General Educational Development (GED) Information High school attended ____________________ City ______________________ State ______ High School graduation date ______________ GED test date __________________ Official high school transcript or scores from the GED test must be submitted to the Admissions Office. College (s) attended since high school graduation ______________________________________   Name                                          City            State Official college transcripts must be forwarded to Moraine Valley, Admissions office. Transcripts are evaluated only at the request of the student.