return false; } else if (obj_type == "SINGLE_VALUE_RADIO" || obj_type == "SINGLE_VALUE_CHECKBOX") { if (obj.checked) return true; else return false; } else if (obj_type == "RADIO" || obj_type == "CHECKBOX") { for (i=0; i < obj.length; i++) { if (obj[i].checked) return true; } return false; } } function _CF_checkform(_CF_this) { if (!_CF_hasValue(_CF_this.email, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.email, _CF_this.email.value, "Please enter a valid email address!")) { return false; } } if (!testbox(_CF_this, _CF_this.email, _CF_this.email.value)) { if (!_CF_onError(_CF_this, _CF_this.email, _CF_this.email.value, "Please enter a valid email address!")) { return false; } } if (!_CF_hasValue(_CF_this.dob, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.dob, _CF_this.dob.value, "You must provide your date of birth.")) { return false; } } if (!_CF_hasValue(_CF_this.lastName, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.lastName, _CF_this.lastName.value, "You must provide your last name.")) { return false; } } if (!_CF_hasValue(_CF_this.firstName, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.firstName, _CF_this.firstName.value, "You must provide your first name.")) { return false; } } if (!_CF_hasValue(_CF_this.address, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.address, _CF_this.address.value, "You must provide your mailing address.")) { return false; } } if (!_CF_hasValue(_CF_this.city, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.city, _CF_this.city.value, "You must provide your city.")) { return false; } } if (!_CF_hasValue(_CF_this.state, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.state, _CF_this.state.value, "You must provide your state.")) { return false; } } if (!_CF_hasValue(_CF_this.zip, "TEXT" )) { if (!_CF_onError(_CF_this, _CF_this.zip, _CF_this.zip.value, "You must provide a zipcode.")) { return false; } } return true; } //-->

Student Record Form

NEW STUDENTS: Please submit this form to obtain your WebAdvisor login and password instructions. The instructions will be emailed to you within two business days. During peak times it may take longer to receive your instructions.

CURRENT AND RETURNING STUDENTS: If you would like your WebAdvisor password reset, please click on 'What’s My Password?' in WebAdvisor, email us at firststop@socc.edu, or submit this form.

If you are receiving financial aid, registering for 12 or more credits, or planning to earn a degree and have not been admitted to the college, you must complete an application for admission instead of using this form.

Providing your Social Security Number is voluntary. If you provide it, the college will use your Social Security Number for keeping records, doing research, aggregate reporting, extending credit, and collecting debts. Your Social Security Number will not be given to the general public. If you choose not to provide your Social Security Number, you will not be denied any rights as a student. Please read the statement in the Student Handbook, which describes how your number will be used. Providing your Social Security Number means that you consent to use of the number in the manner described.

Year:		I plan to start enrollment:	Fall Winter Spring Summer
Social Security Number
E-mail Address	Required for ALL students. MUST be a VALID email address.
Date of Birth
Legal Last Name
Legal First Name
Middle Name or Initial
Maiden Name or Other Name Used
Address
City	State
Zip
County
Phone (home)
Phone (work)
Phone (other or cell)
Emergency Contact name
Emergency Contact Phone

Do you have?
High School Diploma
GED
Adult High School Diploma
Still in High School
No Diploma or GED
Home Schooled/Other

Year received or will receive:
Name of school where diploma or GED received:

While at Southwestern do you plan to?

1. Earn a certificate or 2-year degree
2. Earn a high school diploma or GED
3. Just here to take classes
4. Take classes to transfer to another 2-year college
5. Take classes to transfer to a 4-year college
6. Undecided

What is the MAIN reason you are attending Southwestern this term.
1. Take classes to transfer to a 4-year college
2. Learn skills to get a job
3. Improve job skills
4. Explore career or educational options
5. Take classes to finish high school or GED
6. Improve writing, reading, or math skills
7. Learn English
8. Personal enrichment
9. Other

Have you attended college before?
Yes No

Gender: Male Female

Ethnic - voluntary
Non-Hispanic White
Black Non-Hispanic
Hispanic
Asian or Pacific Islander
American Indian or Alaskan Native
Other

Are you a U.S. citizen? Yes No

If no, are you a resident alien?
Yes No

Registration Alien #:
Country:

If no, are you here on a visa?
Yes No

Have you lived in Oregon for the last 90 days?
Yes No

If No, list previous address:

Are you a veteran? Yes No

Would you like to receive information about
special services for students with disabilities? Yes No

How did you hear about Southwestern?
High School/College
Existing Student
Ex-Student
Internet
Family/Friend
Radio
Newspaper
Other

For more information:
Phone: (541) 888-7352
FAX: (541) 888-1513

Southwestern Oregon Community College is an equal access/opportunity institution in compliance with state and federal laws and does not discriminate on the basis of sex, race, color, creed, religion, national origin, age, disability, sexual orientation, or marital status. The EEO officer is Sheldon Meyer and he is available for questions or information on the grievance procedure at (541) 888-7402.

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