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Continuing Education Application
Submit this form to be a part of Snow College's Continuing Education program.
Personal Information
*
Legal First Name
Legal Middle Name
*
Legal Last Name
Marital Status
---
Single
Divorced
Domestic Partner
Married
Other
Separated
Widowed
Maiden Name
Preferred First Name
*
Mailing Address Line 1
Mailing Address Line 2
*
City
*
State
---
Utah
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip code
*
I am a current resident of Utah:
Yes
No
*
I am a U.S. citizen:
Yes
No
*
Student Personal Email
*
Mobile Phone Number
*
Gender
---
Female
Male
Prefer not to say
*
Date of Birth
year
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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
Social Security Number
Federal IRS regulations require Snow College to record your correct Social Security Number (SSN). Snow College confidentially maintains a student's SSN for routine uses, such as facilitating document matching, verifying identity, and expediting enrollment and financial aid.
Disclosure of the social security number is voluntary, but failure to provide the social security number may result in delay and confusion regarding identity; delay or loss of federal and state financial aid, tax credits, student loan deferments, veterans benefits, and other benefits under law.
*
Ethnicity
?
Non-Hispanic/Latino
Hispanic/Latino
Prefer not to say
*
Race
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Unknown
*
Have you ever served in the United States Armed Forces, National Guard, or reserves?
Yes
No