Do not print the form and fill it out by hand.  
 

Enter all the required information online, use the "Print and Sign" button at the bottom of the form to generate the official PDF copy.
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The official copy will have a barcode in the lower left corner and a signature line at the end of the form.
 

After you print and sign the form, bring the form to the Enrollment Services Office on the first floor of Lynnwood Hall, OR fax the form to 425-640-1159, OR mail the form to: 
 
Enrollment Services 
Edmonds Community College 
20000 68th Ave W 
Lynnwood, WA 98036 

Admission Application Form
 Student Name     Last: (Surname):      First:      M.I.: 
 Student ID Number:    -- Help  Birthdate:  //   MM/DD/YYYY
 Year/Quarter:    Help  Social Security Number: -- Optional
  I refuse or am unable to provide my SSN/ITIN at this time.   
Initials:________________
 DISCLOSURE STATEMENT: To comply with federal laws, we are required to ask for your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). If you do not submit your SSN/ITIN, you will not be denied access to the college; however, you may be subject to civil penalties (refer to Internal Revenue Service Treasury Regulation 1.6050S-1 (e)(4) for more information) of a $50 fine in the event of an audit. If you choose not to provide your SSN/ITIN please check the “I refuse...“ box above and write your initials on the line provided.
Street Address:   Apt. # 
 City: State:  Zip: 
 Email:   Cell:   Home: 
 Previous Name(s):  
   Male           Female    
 
A. Services are available for students who have special needs due to a disability. Would you like our SSD staff to contact you with more information?    Yes          No
B. What is your program of study or major area of interest? If you are unsure, refer to the Program Add form.
C. Have either of your parents earned a bachelor’s (4-year) degree?    Yes        No 
Are you a veteran?    Yes  No     Veterans and/or their eligible dependents may qualify for educational benefits.
Are you a veteran’s dependent?    Yes  No     Call 425-640-1502 for more information.
 Have you have been in Washington state foster care for at least one year since your 16th birthday?   Yes  No 
If you are unemployed, underemployed, formerly self-employed but now unemployed, or a displaced homemaker, call (425) 640-1433 or email workerretraining@edcc.edu to see if you qualify for tuition assistance. 
 
D. Are you a U.S. Citizen?    Yes No    If you are not a US citizen, you must indicate what your status is.
  Immigrant/Permanent resident (IM) When was your Permanent Resident card issued? 
  Refugee/Parolee/Conditional Entrant (RF) When was your Alien Number issued? 
  Visa holder; My visa type is: 
        If your visa type is B, F, J, M, or TN, you must go to the International Student Services Office for admission.        
        If your visa type is A, E, G, H, I, K, L, or R, the Enrollment Services Office will admit you.
  Other (please explain): 
E.  1. Were you claimed as a dependent for federal income tax purposes by your mother, father or legal guardian: Yes No
      If YES, how long has your mother, father or legal guardian lived continuously in the State of WA? Years Months
 2. How long have you lived continuously in the state of WA as a legal resident*? Years Months
    * You cannot qualify as a legal resident for tuition purposes if you possess a valid out-of-state driver's license, vehicle registration, or other documents that give evidence of being a legal resident in another state.
 3. Will you be attending this college with financial aid provided by a public or private “non-federal” agency which is “outside the state of Washington” where residency is required for receiving that aid?   
     Yes  No  (If yes, please attach explanation.)
 4. Are you active duty military stationed in Washington?     Yes  No 
 Are you the spouse or dependent of an active duty military person stationed in Washington?     Yes  No 
F.  1. Have you earned a GED?     Yes  No   If yes, where:   Year: 
 2. Last high school attended:  State/Country:
    Years attended   to:            Graduated?  Yes  No 
    Date you graduated or expect to graduate from high school     Month:       Year: 
 3. Have you earned a 4–year bachelor’s degree or above (or equivalent from a foreign country)? Yes  No
 4. Last college/university attended:  State/Country:
    Years attended   to:            Graduated?  Yes  No 
 5. Other college/university attended:  State/Country:
    Years attended   to:            Graduated?  Yes  No 
G.  Which race(s) do you consider yourself to be? (Optional) (Mark up to two boxes)
  Alaska Native   Cambodian   Indonesian   Samoan
  American Indian**   Chinese   Japanese   Taiwanese
  Arabian   Eskimo   Korean   Thai
  Asian – Indian   Fijian   Nepali   Tlingit
  Asian – Other   Filipino   Pacific Islander – Other   Vietnamese
  Black or African American   Hawaiian – Native   Pakistani   White
  Other Race: 
  ** If American Indian, please list name of enrolled or principal tribe: 
 Are you of Spanish/Hispanic origin? (Optional) (Please mark only one box)
  No, (not Spanish/Hispanic)   Yes, Mexican, Mexican-Am., Chicano   Yes, Spanish
  Yes, Central American   Yes, Puerto Rican  
  Yes, Cuban   Yes, South American   
  Yes, other Spanish/Hispanic: 
H.  I herby certify under penalty of perjury under the laws of the state of Washington RCW 9A.72.085 that to the best of my knowledge, all statements on this form are true and correct.
 
 
 
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