| Social Security Number |
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| Date of Birth |
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| Gender |
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| First Name |
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| Middle Name |
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| Last Name |
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| Suffix |
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| Previous Name (if any) |
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| Email |
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| Verify Email |
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| Permanent Address |
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| City |
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| State |
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| Zipcode |
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| County of Residence |
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| Country |
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| Home Phone |
( )
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| Work Phone |
( )
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| Cell Phone |
( )
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*Please fill out mailing address only if it is different from your permanent address.
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| Mailing Address |
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| City |
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| State |
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| Zipcode |
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| County of Residence |
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| Country |
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Ethnic Background:
A response to the following question is solely voluntary and the information will be kept confidential. Refusal to provide this information will not subject the applicant to any adverse treatment |
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| Citizenship |
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U.S. Citizen
Non-Immigrant (Student/Visitor)
Refugee
*Permanent Resident
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| (*A copy of both sides of your green card will be required.) |
| Did you ever receive EOF at a previous Institution? |
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Yes
No |
| If yes, what institution ? |
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| Do you wish to be considered for EOF at NJCU? |
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Yes
No |
| If yes, how many people are in your immediate family? Include your parents when counting family memebers. |
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| If yes, what is your annual family income? |
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| Are you eligible for veterans benefits? |
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Yes
No |
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| Expected College Entrance: |
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| Will you be applying for Campus Housing? |
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Yes
No |
| Will you be applying for Financial Aid? |
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Yes
No |
| Are you applying as a NJCU Communiversity Student? |
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Yes
No |
| Application Status: |
What are these? |
| Attendence Status: |
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| Intended Major: |
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| Have you ever applied for admissions to NJCU? |
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Yes
No |
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If yes, select year
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