Chemeketa Underage Admission Application

Personal Information

First Name

Middle Name

Last Name

Suffix

Birthdate

SSN (Optional)

Legal Sex

Please select whether or not you are from a Hispanic background.

Please select any descriptions which apply to your race (optional).

Contact Information

Email Address

Mobile Phone Number

Landline Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Academic Intention

Indicate your high school status:

This application is not for High School or GED graduates. Your application will not be submitted.

Please contact the High School Partnerships office at 503.399.5293 for assistance.

Enrollment Term

Program List

Campus Location

Please indicate specific course you wish to enroll (Optional):

Parent/Legal Guardian Information

Relationship Type

Parent / Legal Guardian First Name

Parent / Legal Guardian Last Name

Parent / Legal Guardian Phone Number

Parent / Legal Guardian Email

My Parent/Legal Guardian does not have an email address

School Information

Type in the name of your high school and select the correct high school as options start to populate.

For students who were home schooled, please begin typing Home School into the field and select *Home School from the options as it populates.

If you do not see your high school listed, please select the "*I don't see my high school listed" option.

High School Name (Last Attended)

I do not know my school counselor information

School Counselor Name

School Counselor Email

Academic Survey Information for College Placement

What is your current High School GPA

What is your most recent Trimester/Semester English Grade

What is your most recent Trimester/Semester Math Course

What is your most recent Trimester/Semester Math Grade

Chemeketa Community College releases only very limited information regarding students: enrollment status, dates of enrollment, degree or certificate, program of study, athletic statistics or honors awarded. If you do NOT want any person outside of the college, including prospective employers, to know any of these, you must file a request for Non-Disclosure of Student Information form with the Admissions office.

I certify that all statements on this application are complete and true. I also understand that if I am admitted and do not enroll for the term to which I am admitted, I will need to reapply for admission. Submitted materials will not be returned nor duplicated.