Academic Information
Personal Information
Residency
Contact
Please list the high school you attended or the state that issued your GED.
High School: __________________________________________________ City/State ______________________
Graduation Year: __________ Diploma GED Year Issued: _________
(A copy of GED certificate must accompany this
application)
Please list the colleges you have attended in order of attendance. Official transcripts must be sent directly from the
high school and ALL colleges attended to Casper College Admissions.
College Attended City/State Years of Attendance
___________________________________________________
_________________ ___________________
___________________________________________________
_________________ ___________________
___________________________________________________
_________________ ___________________
___________________________________________________
_________________ ___________________
Have you resided in Wyoming continuously for the last year?
Yes
No
If no, when did your most recent period of continuous presence in Wyoming begin? Month _______ Year _______
Please list your mailing addresses for the past two years:
Year _______ Address ____________________________________City/State __________________Zip ________
Year _______ Address ____________________________________City/State __________________Zip ________
Do you have a current Wyoming driver's license? Yes No Issue date ________ Expiration date _________
Do you own a motor vehicle? Yes No If yes, date and state of registration: __________________________
Did you attend college during the past year? Yes No If yes, list institution: _________________________
U.S. Citizen?: Yes No
If no, are you a permanent resident?: Yes No Citizen of:
Ethic background (optional) African American American Indian Asian Caucasian Hispanic
In case of emergency please contact:
Name _____________________________________ Phone Number ( ) -
Legal Name:
Maiden/Previous Name:
Gender: Male Female
Social Security No.:
- -
Birthdate:
/ /
Permanent Mailing Address:
Local Mailing Address:
Home phone
( ) -
Cell phone
( ) -
E-mail:
Last
First
Middle
Street City State Zip
Street City State Zip
Applying as a:
New Student Transfer Student Returning CC Student Other (specify)_______________________
Applying for term beginning: Fall _________(year) Spring _________(year) Summer _________(year)
Please complete both sides of the application. Continued on next page
How did you hear about us?
Internet
Job Fair
High School Counseler
Admissions Representative
Friend
Advertisment : Where?
Other