6/26/2021 Blue Ridge Community College — Student Print Application Student Print Confirmation number: 3228-002222-5-06252021-01097068-00724980 Date submitted: June 25, 2021 at 8:18:37 PM 1. THE BASICS Legal Name Last name: Bristol First name: Juanita Middle name: Suffix: Do you have another name you prefer to be called? No Other Important Information Birthdate: 08/30/2000 Social Security number (SSN): ***-**-8260 What is your gender identity? Prefer not to answer Are you Hispanic or Latino/a? Prefer not to answer What is your racial or ethnic identification? https://www.apply.vccs.edu/applications/VCCS/student_print/VCCS_student_print.asp?confirmation_number=3228-002222-5-06252021-01097068-00… 1/5 6/26/2021 Blue Ridge Community College — Student Print Prefer not to answer Have you ever applied, attended, or worked at any community college in Virginia? Yes Student ID (EMPLID) number: 7884729 2. COMMUNICATING WITH YOU Mailing Address Country: United States Street/PO Box: 2022 Worthington Drive 2022 Worthington Drive City: texas U.S. state/territory: TEXAS Zip code: 75240 Is this also your permanent/home address? Yes Additional Contact Information Has Virginia been your home for the past 12 months or more? Personal e-mail address: lemon001shop@gmail.com Telephone: (214) 621-1423 https://www.apply.vccs.edu/applications/VCCS/student_print/VCCS_student_print.asp?confirmation_number=3228-002222-5-06252021-01097068-00… 2/5 6/26/2021 Blue Ridge Community College — Student Print Type: Cell Would you like to get important updates from the college by text message? No If you plan to apply for financial assistance, Federal Financial Aid guidelines require that we obtain your voluntary consent to use electronic means, such as email, to provide you with information: I agree and have reviewed the guidelines 3. YOUR EDUCATION Which of the below describes your current high school education? I am currently a home schooled student in the U.S. Expected completion date: 10/2022 College/University Information Have you attended any other college(s)? No Program of Study I plan to earn a degree, certificate, or diploma at Blue Ridge Community College: Yes Choose which area you are most interested in studying at Blue Ridge Community College: 8 Program of study: 299|G3 Information Systems Technology (IST) I plan to start classes in: 2022 Spring (01/10/22 - 05/07/22) Which of the following best describes your high school situation? I am taking some classes through my high school AND some classes on my own for college credit only. 4. YOUR MILITARY SERVICE https://www.apply.vccs.edu/applications/VCCS/student_print/VCCS_student_print.asp?confirmation_number=3228-002222-5-06252021-01097068-00… 3/5 6/26/2021 Blue Ridge Community College — Student Print Military Information Have you served or are you currently serving in the U.S. military? No Are you a dependent or spouse of someone who is currently serving or has served in the U.S. military? No 5. YOUR BACKGROUND Parent(s) Education Level What best describes your parent(s) highest level of education? Parent 1: I am not sure Parent 2: I am not sure Residency What is your current status? Other category not listed above What is your primary spoken language? English You may apply for in-state tuition based on your own domicile or your spouse, parent or legal guardian's domicile: I want to claim eligibility based on my own domicile I am under age 24 and want to claim eligibility based on my own domicile for the following reason(s): I am financially self-sufficient Your Domicile Information https://www.apply.vccs.edu/applications/VCCS/student_print/VCCS_student_print.asp?confirmation_number=3228-002222-5-06252021-01097068-00… 4/5 6/26/2021 Blue Ridge Community College — Student Print - End of Document - https://www.apply.vccs.edu/applications/VCCS/student_print/VCCS_student_print.asp?confirmation_number=3228-002222-5-06252021-01097068-00… 5/5