SCT WWW Information System
Admission Application

Personal Information

INFO Much of the information in this section is optional. However, your Residency Status is required to complete your application. Providing your Social Security Number is appreciated. Multiple medical conditions may be specified.

Confidentiality Required: Yes No Not Reported
Citizenship Status:
Residency Status:
Gender: Male Female Not Reported
Birth Date: (MM/DD/YY format)
Social Security/Tax ID Number:
Marital Status:
Religion:
Ethnic Group:
E-Mail Address:
Has any family member attended this institution?
Select any special medical conditions you may have:

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