Print
Applicant Information
Contact Information
Academic Information
Acknowledgement
Academic
Acknowledgement
Required
is required
is Required
First Name
Required
Middle Name
Required
Last Name
Required
Preferred Name
Required
Suffix
Required
-- choose one --
DDS
I
II
III
IV
Jr.
MD
PHD
Sr.
V
Email Address
Required
Social Security Number
Confirm Social Security Number
Date of Birth
Required
Gender
Required
-- choose one --
Female
Male
Prefer Not to Answer
Are you Hispanic or Latino?
Required
-- choose one --
NO
YES
Select one or more of the following races:
Required
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Citizenship Status
Required
-- choose one --
Non-Resident Alien
Resident Alien
US Citizen
Citizenship Country
Required
-- choose one --
UNITED STATES
CANADA
AFGHANISTAN
ALBANIA
ALGERIA
ANDORRA
ANGOLA
ANTIGUA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA
BOTSWANA
BRAZIL
BRUNEI
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CAMBODIA
CAMEROON
CAPE VERDE
CENTRAL AFRICAN REPUBLIC
CEYLON
CHAD
CHILE
CHINA
COLOMBIA
COMOROS
CONGO
COSTA RICA
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
ENGLAND
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FIJI
FINLAND
FRANCE
FRENCH ANTILLES
FRENCH GUIANA
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GREECE
GRENADA
GUADELOUPE
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HOLY SEE
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA
KUWAIT
KYRGZSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MEXICO
MICRONESIA
MOLDOVA
MONACO
MONGOLIA
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NORTH KOREA
NORTHERN IRELAND
NORWAY
OMAN
PAKISTAN
PALAU
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
PRINCIPE
QATAR
REPUBLIC OF CHINA
ROMANIA
RUSSIA
RWANDA
SAN MARINO
SAO TOME
SAUDI ARABIA
SCOTLAND
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEON
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH KOREA
SOUTH-WEST AFRICA
SPAIN
SRI LANKA
ST. KITTS
ST. LUCIA
ST. NEVIS
ST. VINCENT
SUDAN
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKSTAN
TANZANIA
THAILAND
THE GRENADINES
TOBAGO
TOGO
TONGA
TRINIDAD
TUNISIA
TURKEY
TURKMENISTAN
TUVALU
UAE
UGANDA
UKRAINE
UNITED KINGDOM
UPPER VOLTA
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIETNAM
WALES
WEST AFRICA
WEST INDIES
WESTERN SAMOA
YEMEN
ZAIRE
ZAMBIA
ZIMBABWE
Visa Status
Required
-- choose one --
A-1/A-2
B-1/B-2
E-1/E-2
F-1/F-2
H-1B/H-3/H-4
J-1/J-2
K1 - K4
L-1/L-2
NATO N1 - N7
R-1/R-2
TN / TD
Check here if you want to opt out of text messages
Required
is Required
Physical Address
Street 1
Required
City
Required
State
Required
-- choose one --
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
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
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
Required
Zip Code Extension
Home Phone
Required
Home Phone Area Code
Home Phone Exchange
Home Phone Number
Home Phone Extension
Ext:
Mobile Phone
Required
Mobile Phone Area Code
Mobile Phone Exchange
Mobile Phone Number
Mobile Phone Extension
Ext:
Mailing Address (if different than above)
Street
Required
City
Required
State
Required
-- choose one --
ALABAMA
ALASKA
AMERICAN SAMOA
ARIZONA
ARKANSAS
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
GUAM
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
PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGIN ISLANDS
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
Zip Code
Required
Zip Code Extension
Choose the following that best describes your education status:
is Required
Personal Information
is Required
Highest Level of Education
Required
-- choose one --
College
GED
High School
High School Graduation Month
Required
-- choose one --
January
February
March
April
May
June
July
August
September
October
November
December
High School Graduation Year
Required
-- choose one --
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
High School Attended
Required
Last College Attended (if applicable)
Required
Program of Interest
Required
-- choose one --
Agriscience
Automotive Maintenance
Building Trades
Cosmetology
Culinary
Dental Assistant Specialist
Education
Emergency Medical Technician (EMT)
Fire Science
General Studies
HVAC
Marketing Management
Medical Assistant
Mental & Social Health Technician
Nursing Assistant
Patient Care Technician
Phlebotomist Technician
Theatre
Personal Enrichment/No Major
Welding
Anticipated Starting Semester
Required
-- choose one --
Summer 2025
Fall 2025
Spring 2026
Summer 2026
Are you a member or veteran of the U.S. armed forces?
Required
-- choose one --
No
Yes
Do you plan on seeking Financial assistance?
Required
-- choose one --
No
Yes
Campus you plan to attend:
Required
-- choose one --
Gila Pueblo
Payson
Online
Check the box if you ARE a first-generation student (neither of your parents have completed a 4-year degree)
Required
is Required
Today's Date
Required
Signature (Please type your full name)
Required
Student Type:
Required
-- select one --
College Transfer
First Time College Student
Returning Student
High School Student
Reason for Enrollment
Required
-- select one --
Employment Reasons
Transfer
Personal Interest
Undecided
Are you a legal Arizona Resident?
Required
-- select one --
Yes
No
Are you a dependent of a U.S. Veteran?
Required
-- select one --
Yes
No
If applicable, date present stay in Arizona began (mm/yyyy):
Required
Arizona county of residence:
Required
Date you moved to this county:
Required
Are you GED Certified?
Required
-- select one --
Yes
No
If yes, what date did you receive your GED?
Required
If you attended a previous college, what was your last date of attendance
Required
Are you currently enrolled as a high school student?
Required
-- select one --
Yes
No
I certify the information provided in this application is complete and accurate to the best of my knowledge. I understand that submission of false information is grounds for denial of admission or immediate suspension if enrolled. As a Gila Community College student, I agree to abide by the rules and regulations regarding conduct and other obligations as dictated in the course catalog. By submitting this application, I verify the above to be true. Gila County Community College District, in compliance with state and federal laws and regulations, commits to providing equal opportunities for employment and advancement, admission, and access to educational programs or activities.
Gila Pueblo Campus
|
8274 S. Six Shooter Canyon Rd. | Globe, AZ 85501 | 928-425-8481