application for admission

www.BramsonORT.edu
APPLICATION FOR ADMISSION
Dear Applicant:
Please read the following and complete the application as accurately as possible.
PRINT or TYPE ALL YOUR RESPONSES.
Thank you
HOW TO APPLY:
1. Please answer all questions on the application and be sure to sign the application before submitting it to
Bramson ORT College.
2. Please enclose your non-refundable application fee with this application form.
3. Please enclose an official high school diploma or GED document, and send to the Bramson ORT College
Admissions Office.
4. If you have studied at other postsecondary institutions, please have your official transcripts sent to the
Bramson ORT College Admissions Office.
5. New York State Public Health Law 2165, requires all students who were born on or after January 1,
1957, to be immunized against measles, mumps, and rubella. Students must submit documentation of
immunization before classes begin.
6. Please be prepared to present a valid Picture ID in order to take the Entrance Exam.
Please send the completed application to:
E-mail: admissions@bramsonort.edu
Bramson ORT College’s Notice of Non-Discrimination
Bramson ORT College does not discriminate on the basis of race, color, national origin, sex, disability, age, veteran status, gender ori- entation, or weight in its programs
and activities. Bramson ORT College does not discriminate in admissions of students, employment or in administration of its educational policies, scholarship and loan
programs, and other College administered programs. Bramson ORT College has internal grievance and complaint procedures to investigate allegations of discrimination
and/or sexual harassment. Questions or complaints regarding the policy or initiation of any grievance may be directed to the Title IX and Section 504 Coordinator.
Aicha Cesar
Civil Rights Compliance Officer
718-261-5800, Extension 1075
acesar@bramsonort.edu
718-704-1407 (TTY, Main Campus)
718-234-4022 (TTY, Brooklyn Extension Center)
BORT MC GD ARU 09/19/14
Bramson ORT College
Admissions Office
69-30 Austin Street
Forest Hills, New York 11375
COMPLETE EACH OF THE FOLLOWING ITEMS:
All information will be kept confidential. Disclosure of Social Security Number is optional and is used only to maintain student records.
1
Social Security Number:
2
Name:
3
Request for admission in Year:
4
Address:
Last (Family Name)
8
Middle
(Other Last name used)
Semester: Fall
Spring
Summer
Apt.
City
Phone Number Home: (
Work: (
7
First
Street
5 Email address:
6
(Optional)
Date of Birth: Month
State
Zip Code
@
)
Cell: (
)
Length of residence in New York State:
9
Are you a United States Citizen? Yes
10
Immigration Status:
Day
No
)
Year
Years
Months
If the answer to question 9 is NO, answer question 10.
Permanent Resident
Alien Registration Card Number
Student Visa
Date Issued
Other (please specify)
11
Expiration Date
Please indicate how you heard about Bramson ORT College:
ACADEMIC INFORMATION
HIGH SCHOOL/SECONDARY INFORMATION
Official copies of high school transcripts or GED scores and diploma award certificates must be sent to the Office
of Admissions.
12
Name (or number) of High School:
13
City:
Country:
Date of High School Graduation or Receipt of GED: Year
14
Month
or
Last day of High School attendance, dismissal or discharge if did not graduate:
Year
Last Grade
EMERGENCY CONTACT
First Name
Last Name
Cell Phone Number
Home/Work Phone Number
Relationship
First Name
Last Name
Cell Phone Number
Home/Work Phone Number
Relationship
POSTSECONDARY SCHOOL INFORMATION
To be filled out only by applicants who have attended a University, Institute of Higher Education, Polytechnic
or any other postsecondary institution. Transcripts of all work completed must be sent to the Admissions office.
15 List all postsecondary schools you attended in the United States or Abroad.
Institution
16
City/Country
Dates of Attendance
I AM APPLYING FOR ENROLLMENT AS A:
Matriculant
Other (Specify):
Matriculant/ATB
Auditor (no credits given)
In the following programs of study:
DEPARTMENT OF ACCOUNTING
Accounting
(AAS)
Bookkeeper
(Certificate)
Accounting
(Diploma)
DEPARTMENT OF BUSINESS MANAGEMENT
Business Management
(AAS)
General Management
Sales Management
Hospitality Management
Business Management Online
(AAS)
Small Business Management
(Certificate)
Business Management
(Diploma)
DEPARTMENT OF COMPUTER TECHNOLOGY
Computer Information Systems
(AAS)
CADD Applications
Computer Network
Computer Programming
Game Design
Graphic Design
Game Design and Programming
(AAS)
Graphic Design
(Certificate)
Game Design
(Certificate)
Computer Operations
(Certificate)
Computer Sales
(Certificate)
Intensive Programmer
(Certificate)
Junior Programmer
(Certificate)
Computer Programming
(Diploma)
Diploma or Degree Received
Non-Matriculant
College Now
DEPARTMENT OF ELECTRONICS TECHNOLOGY
Electronics Technology
(AAS)
General Electronics Technology
Home Technology Integration
HVAC Control Systems
Renewable Energy
Electronics Technology
(Certificate)
Renewable Energy
(Certificate)
Electronics Technology
(Diploma)
DEPARTMENT OF MEDICAL AND SCIENCE
Medical Assistant
(AAS)
Pharmacy Technician
(AAS)
Pharmacy Technician
(Certificate)
DEPARTMENT OF OFFICE TECHNOLOGY
Administrative Assistant
(AOS)
General Office Assistant
Medical Office Assistant
Professional Billing and Coding Assistant
Medical Office Assistant
(Certificate)
Secretary
(Certificate)
Word Processing
(Certificate)
Secretarial Studies
(Diploma)
DEPARTMENT OF PARALEGAL
Paralegal
(AAS)
STUDENT DISCLOSURE AGREEMENT
I certify that, to the best of my knowledge, the information I provided on this ADMISSIONS
APPLICATION is accurate and true.
Applicant’s Signature:
Date:
Admissions Officer’s Signature:
Date: