18345 Campus Way NE, Bothell, Washington 98011-8205
Submit this form in person or by mail to Cascadia’s Enrollment Services Office (address at left),
or by fax at 425.352.8137. Or apply online at www.cascadia.edu/admissions.
Questions? Please call 425.352.8534 or e-mail: firstname.lastname@example.org.
List previous last name
Address (number and street/apt. #)
Day phone number
Evening phone number
OPTIONAL INFORMATION: The following information is being requested to help us determine the needs of our community.
❑ Hispanic/Latino (717)
❑ Mexican, Mexican-American (722)
❑ Black/African-American (872)
❑ Native American Indian (597)
❑ Latin American/South/Central/Caribbean/Other Spanish (799)
❑ Other Ethnicity
Shaded areaS for office uSe only
Social Security Number
Quarter you plan to start:
❑ Summer ❑ Fall ❑ Winter ❑ Spring
Have you ever applied for or attended classes offered by Cascadia?
❑ YES ❑ NO If yes, when?
Your intended degree:
Student Program Applied
If undecided, what area interests you most?
Will you attend
❑ Days ❑ Evenings
Do you plan to transfer to a
❑ YES ❑ NO
Date of Receipt of Application
❑ Male ❑ Female
Are you a US citizen? ❑ Yes ❑ No If no, list the country of citizenship:
If not a U.S. citizen, what type of Visa do you have? ❑ Visitor ❑ International Student (with F or M Visa)
❑ Immigrant/Permanent Resident: Alien#
❑ Temporary Resident: Alien #
❑ Refugee/Parolee or Conditional Entrant: Alien #
❑ Other (Explain)
CITIZENSHIP (required information)