Date of Birth
(MMDDYYYY)
Gender
Female
Male
Ethnic Background
White, Non-Hispanic
Black, Non-Hispanic
Hispanic
Asian or Pacific Islander
American Indian or Alaskan Native
International
Please answer all race categories below.
Hispanic/Latino?
Yes
No
American Indian/Native American?
Yes
No
Asian?
Yes
No
Black?
Yes
No
Hawaiian/Pacific Islander?
Yes
No
White?
Yes
No
Marital Status
Married
Unmarried
Divorced/Separated
Widow/Widower
If not, give type of U.S. visa held or
to be obtained
B1
F1
J1
Other
PR - Immigrant
None
Date of Issue
Are you a Veteran?
No
Chapter 30-Active Duty/Discharged from Active
Duty
Chapter 31-Service Disabled Veteran
Chapter 32-VEAP
Chapter 33-Post 911 GI Bill
Chapter 35-Dependent: wife, widow, or child
Chapter 1606-Selected Reserves
If yes, do you receive VA benefits?
Yes
No
Are you active military?
Yes
No
Are you a military dependent?
Yes
No
IV.
Educational Information
Are you entering college
for the first time?
Yes
No
If no, enter last college attended
None
Abilene Christian University
Abilene Christian University Metrocenter
Alamo Community College District
Alvin Community College
Amarillo College
Amber University
Angelina College
Angelo State University
Austin College
Austin Community College
Baylor University
Bee County College
Blinn College
Brazosport College
Brookhaven College (Dallas CCCD)
Cedar Valley College (Dallas CCCD)
Central Texas College
Cisco College
Clarendon Junior College
Coastal Bend College
College of the Mainland
Collin County Community College District
Concordia Lutheran College
Dallas Baptist College
Del Mar College
East Texas Baptist University
Eastfield College (Dallas CCCD)
El Centro College (Dallas CCCD)
El Paso Community College Disstrict
El Paso Community College - Mt. Campus
El Paso Community College - Valleverde
Frank Phillips College
Galveston College
Grayson County College
Hardin Simmons Univeristy
Hill College
Houston Baptist University
Houston Community College
Howard College
Howard Payne College
Huston Tillotson College
Jacksonville College
Jarvis Christian College
Kilgore College
Lamar University
Lamar University at Orange
Lamar University at Port Arthur
Laredo Community College
Lee College
Letourneau College
Lon Morris College
Lubbock Christian College
McLennan Community College
McMurray College
Midland College
Midwestern State University
Moody College
Mountain View College (Dallas CCCD)
Navarro College
Never Attended
North Central Texas College
North Harris Montgomery Cnty College Dist
North Lake College (Dallas CCCD)
Odessa College
Our Lady of the Lake University
Out-of-State College
Panola College
Paris Junior College
Paul Quinn College
Prairie View A&M University
Ranger College
Rice University (William Marsh)
Richland College (Dallas CCCD)
Sam Houston State University
San Antonio College (Alamo CCD)
San Jacinto College Central Campus
San Jacinto College North Campus
San Jacinto College South Campus
Schreiner College
South Plains College
South Texas College of Law
Southern Methodist University
Southwest Texas Junior College
Southwest Texas State University
Southwestern Adventist University
Southwestern Assemblies of God University
Southwestern Christian Colle
Southwestern University
St. Edward's University
St. Mary's University
St. Phillips College (Alamo CCD)
Stephen F. Austin State University
Sul Ross State University
Sul Ross State University Rio Grande College
Tarleton State University
Tarrant County Junior College Northeast Campus
Tarrant County Junior College South Campus
Temple College
Texarkana College
Texas A&M International University
Texas A&M University
Texas A&M University - Commerce
Texas A&M University - Corpus Christi
Texas A&M University at Galveston
Texas A&M University - Kingsville
Texas A&M University System
Texas A&M University - Texarkana
Texas Christian University
Texas College
Texas Luthern College
Texas Southern University
Texas Southmost College
Texas State Technical College-Harlingen
Texas State Technical College-West Texas
Texas State Technical College-Waco
Texas Tech University
Texas Wesleyan College
Texas Women's University
Trinity University
Trinity Valley Community College
Tyler Junior College
University of Central Texas
University of Dallas
University of Houston - Clear Lake City
University of Houston - Downtown
University of Houston at Victoria
University of Houston
University of Houston System
University of the Incarnate Word
University of Mary Hardin Baylor
University of North Texas
University of St. Thomas
University of Texas at Arlington
University of Texas at Austin
University of Texas at Brownsville
University of Texas at Dallas
University of Texas at El Paso
University of Texas at Pan American
University of Texas at Permian Basin
University of Texas at San Antonio
University of Texas at Tyler
University of Texas System
Vernon Regional Junior College
Victoria College
Wayland Baptist College
Weatherford College
West Texas A&M University
Western Texas College
Wharton County Junior College
Wiley College
William Marsh Rice University
Your student classification will
be:
Not Reported
Freshman (<30 hrs)
Sophmore (>29 hrs)
Unclassified (>72 hrs/no degree)
Associate Degree
Baccalaureate or above
Continuing Education Non Credit
This application is for
Fall
December Mini Mester
Spring
May Mini Mester
Summer I
Long Summer
Summer II
August Mini mester
of  
20
23
24
25
Will you be attending high school
while enrolled at Cisco College?
Yes
No
What is your intended
Program/Major? Non credit students please choose Non credit. Dual
credit students choose "Dual Credit/General Studies".
Dual Credit/General Studies
Automotive Technology
Child Care Development
Cosmetology Operator Cert
Cosmetology Instructor Cert
Barber
Criminal Justice
Elementary Education
Fire Academy
Fire Technology Certificate
Firefighter Certificate
General Studies-Associate of Arts
General Studies-Assoc of Science
HVAC
Industrial Technology
Management
Medical Assistant
Continuing Ed Non-Credit
Nursing - ADN
Nursing - LVN
Nursing - Pre-Nursing Studies
Pharmacy Technician
Real Estate Certificate
Respiratory Technician
Secondary Education
Surgical Technician
Welding Certificate
What is your educational intent?
Earn associates degree
Earn certificate
Earn credits for transfer
Get a new job/improve skills
Attend courses for personal enrichment
(Only degree and/or
certificate-seeking students
are eligible for Federal/State Financial Aid.)
Which campus do you wish to
attend?
Cisco-Main Campus
Abilene Educational Center
If you have a physical or
learning disability that may require special accomodations, please contact
the Special Populations Coordinator at the location you plan to attend.
The Special Populations Coordinator at the Cisco Campus may be reached
at 254-442-5023. The Abilene Center Special Pops Coordinator may be
reached at 325-794-4406
V. Educational
Background
VI. Core Residency
Questions
Texas Higher Education Coordinating Board rule 21.25 requires each student
applying to enroll at an institution to respond to a set of core residency questions
for the purpose of determining the student's eligibility for classification as a resident.
* PREVIOUS ENROLLMENT (FOR ALL STUDENTS)
1. During the 12 months prior to the term for which you are applying,
did you attend a public college or university in Texas in a fall or spring term?
Answer:
No
Yes
If you answered "NO", continue to RESIDENCY CLAIM.
If you answered "YES", complete question 2.
2. What Texas public institution did you last attend?
Answer:
1. Are you a resident of Texas?
Answer:
Yes
No
* ACQUISITION OF HIGH SCHOOL DIPLOMA OR GED
1a. Did you graduate or will you graduate from a high school or
complete a GED in TX prior to the term for which you are applying?
Answer:
Yes
No
1b. If you graduated or will graduate from high school
what was the name and city of the school?
HS Name:
City:
State:
Texas
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Foreign
2. Did you live or will you have lived in TX the 36 months leading
up to the high school graduation or completion of the GED?
Answer:
No
Yes
3. When you begin the semester for which you are applying, will you have
lived in TX for the previous 12 months?
Answer:
No
Yes
4. Are you a U.S. Citizen or Permanent Resident?
Answer:
No
Yes
* BASIS OF CLAIM TO RESIDENCY.
To be completed by everyone who did not answer "YES"
to questions 1a, 2 and 3 in ACQUISITION OF HIGH SCHOOL DIPLOMA
OR GED SECTION.
1. Do you file your own federal income tax as an independent tax payer?
An independent tax payer should not be claimed as a dependent for tax purposes
by another person. If you file a joint return with your spouse, answer "YES".
Answer:
Yes
No
2. Are you claimed as a dependent or are you eligible to be claimed
as a dependent by a parent or court-appointed legal guardian?
To be eligible to be claimed as a dependent, your parent or legal guardian must provide
at least one-half of your support. A step-parent does not qualify as a parent if he/she
has not adopted the student.
Answer:
Yes
No
3. If you answered "NO" to both questions above, who provides
the majority of your support?
Answer:
NOT APPLICABLE
Self
Parent or Guardian
Other (please list below)
Other Source of Support:
* QUESTIONS FOR STUDENTS WHO ANSWERED "YES" TO QUESTION 1
OR "SELF" TO QUESTION 3 IN THE BASIS OF CLAIM TO RESIDENCY SECTION
1. Are you a foreign national whose application for Permanent Resident Status
has been preliminarily reviewed?
You should have received a fee/filing receipt or Notice of Action (I-797)
from USCIS showing your I-485 has been reviewed and has not been rejected.
Answer:
No
Yes
2. Are you a foreign national here with a visa or are you
a Refugee, Asylee, Parolee or here under Temporary Protective Status?
If so, indicate which.
Answer:
NOT APPLICABLE
Visa
Refugee
Asylee
Parolee
Temporary Protective Status
3. Do you currently live in Texas?
If you are out of state due to a temporary assigment by your employer
or another temporary purpose, please answer "NO" and explain in the GENERAL COMMENTS below.
Answer:
No
Yes
4a. If you currently live in Texas, how long have you been living here?
Answer:
NOT APPLICABLE
Less than 12 Months
More than 12 Months
4b. What is your main purpose for living in the state?
If for reasons other than those listed below, please explain in the GENERAL COMMENTS section below.
Answer:
Go to College
Establish/maintain a Home
Work Assignment
5a. If you are a member of the U.S. Military, is Texas your Home of Record?
Answer:
NOT APPLICABLE
Yes
No
5b. If not, what state will have been listed as your military legal residence
for tax purposes on your Leave and Earnings Statement for the 12 months
prior to enrollment?
State:
NOT APPLICABLE
Texas
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
6a. Hold the title (Warranty, Deed, Deed of Trust, or other
similar instrument that is effective to hold title) to
residential real property in Texas?
Answer:
Yes
No
If "YES", date acquired (MMDDYYYY)?
6b. Do you have ownership interest and customarily manage
a business in Texas without the intention of liquidation in the forseeable future?
Answer:
Yes
No
If "YES", date acquired (MMDDYYYY)?
7a. While living in Texas, have you been Gainfully Employed for a period
of at least 12 consecutive months?
Gainful Employment requires an average employment of at least 20 hours per week
for one year or earnings equal to at least half of tuition and living expenses for
one 9-month academic year. Employment conditioned on student status such as
work-study, the receipt of stipends, fellowships or reseach or teaching assistanceships
does not constitute gainful employment.
Answer:
Yes
No
7b. While living in Texas, have you received primary support from a
social service agency for a period of at least 12 consecutive months?
Answer:
Yes
No
8a. Are you married to a person who has been classified as a Texas
resident by a Texas public institution or who could answer "YES"
to any part of question 6 or 7?
Answer:
Yes
No
8b. If "YES" on question 8a, indicate which question (and which part of the question)
could be answered "YES" by your spouse.
8c. How long will you have been married to the Texas resident prior to enrollment?
Answer:
NOT APPLICABLE
Less than 12 Months
More than 12 Months
* QUESTIONS FOR STUDENTS WHO ANSWERED "YES" TO QUESTION 2
OR "PARENT OR GUARDIAN" TO QUESTION 3 IN THE BASIS OF CLAIM TO RESIDENCY SECTION
1. Is the parent or legal guardian upon who you base your claim of residency a U.S. Citizen?
Answer:
NOT APPLICABLE
No
Yes
2. Is the parent or legal guardian upon who you base your claim of residency
a Permanent Resident?
Answer:
NOT APPLICABLE
No
Yes
3. Is the parent or legal guardian a foreign national whose application for Permament Resident Status
has been preliminarily reviewed?
He or she should have received a fee/filing receipt or Notice of Action (I-797)
from USCIS showing your I-485 has been reviewed and has not been rejected.
Answer:
NOT APPLICABLE
No
Yes
4. Is the parent or legal guardian a foreign national here with a visa or are you
a Refugee, Asylee, Parolee or here under Temporary Protective Status?
If so, indicate which.
Answer:
NOT APPLICABLE
Visa
Refugee
Asylee
Parolee
Temporary Protective Status
5. Does the parent or legal guardian currently live in Texas?
If he or she is out of state due to a temporary assigment by your employer
or another temporary purpose, please answer "NO" and explain in the GENERAL COMMENTS below.
Answer:
NOT APPLICABLE
No
Yes
6a. If he or she is currently living in Texas, how long has he or she been living here?
Answer:
NOT APPLICABLE
Less than 12 Months
More than 12 Months
6b. What is your parent or legal guardian's main purpose for living in the state?
If for reasons other than those listed below, please explain in the GENERAL COMMENTS section below.
Answer:
NOT APPLICABLE
Go to College
Establish/maintain a Home
Work Assignment
7a. If he or she is a member of the U.S. Military, is Texas his or her Home of Record?
Answer:
NOT APPLICABLE
Yes
No
7b. If not, what state will have been listed as his or her military legal residence
for tax purposes on his or her Leave and Earnings Statement for the 12 months
prior to enrollment?
State:
NOT APPLICABLE
Texas
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
8a. Does the parent or guardian hold the title (Warranty, Deed, Deed of Trust, or other
similar instrument that is effective to hold title) to
residential real property in Texas?
Answer:
NOT APPLICABLE
Yes
No
If "YES", date acquired (MMDDYYYY)?
8b. Does the parent or guardian have ownership interest and customarily manage
a business in Texas without the intention of liquidation in the forseeable future?
Answer:
NOT APPLICABLE
Yes
No
If "YES", date acquired (MMDDYYYY)?
9a. While living in Texas, has your parent or guardian been Gainfully Employed for a period
of at least 12 consecutive months?
Gainful Employment requires an average employment of at least 20 hours per week
for one year or earnings equal to at least half of tuition and living expenses for
one 9-month academic year. Employment conditioned on student status such as
work-study, the receipt of stipends, fellowships or reseach or teaching assistanceships
does not constitute gainful employment.
Answer:
NOT APPLICABLE
Yes
No
9b. While living in Texas, has your parent or legal guardian received primary support from a
social service agency for a period of at least 12 consecutive months?
Answer:
NOT APPLICABLE
Yes
No
10a. Is the parent or legal guardian married to a person who has been classified as a Texas
resident by a Texas public institution or who could answer "YES"
to any part of question 6 or 7?
Answer:
NOT APPLICABLE
Yes
No
10b. If "YES" on question 10a, indicate which question (and which part of the question)
could be answered "YES" by your parent or legal guardian's spouse.
10c. How long will your parent or guardian have been married to the Texas resident prior to enrollment?
Answer:
NOT APPLICABLE
Less than 12 Months
More than 12 Months
Please answer the items below which best describe your current circumstance.
The information provided will only be used for reporting purposes, as mandated by the state.
1. Are you an Individual with disabilities
(defined as a student who meets any of these criteria)?
You have been referred by the Department of Assistive and Rehabilitative Services for education
and training.
You receive services through a special populations state program.
Answer:
No
Yes
2. Do you have limited English speaking ability?
An adult or an out-of-school youth who has limited ability in speaking,
reading, writing, or understanding the English language and
Whose native language is a language other than English; or
Who lives in a family environment in which a language other than English is
the dominant language.
Answer:
No
Yes
3. Were you a homemaker, not working outside the home, prior to this enrollment?
Answer:
No
Yes
4. Are you a Single Parent?
Answer:
No
Yes
5. Are you a Homeless Individual?
Broadly means individuals who lack a fixed, regular, and adequate night time residence.
Answer:
No
Yes
6. Are you currently a youth that is in or have aged out of the foster care system?
"Youth" means an individual who is not younger than age 17 or older than age 24.
Answer:
No
Yes
7. Are you a youth with a parent who is a member of the armed forces or is on active duty?
"Youth" means an individual who is not younger than age 17 or older than age 24.
Answer:
No
Yes
I certify that the information provided in this Application
for Admission is complete and accurate to the best of my knowledge. I further
understand that this information will be relied upon by the officials of the
college in determining my admission and residence status for tuition purposes
and that the submission of false information is grounds for rejection of my
application, withdrawal of an offer of acceptance, cancellation of enrollment,
and/or disciplinary action. I agree to conform to and abide by the letter and the spirit of all policies, rules,
and regulation of Cisco College. Admission to Cisco College is open to
all qualified persons regardless of race, creed, color, sex, disability, age,
religion or national origin.
When you have completed
the Online Application for Admission, click the "Submit" button ONE
TIME ONLY.
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