New Student Interest and Registration Form
First Name:	Last Name:
El Camino College Student ID# (if you already have one):
Mailing Address:
City:
State:	Zip:
High School Attended:
Phone Number:	Message Number:
Email:
Background Information
Are you the first person in your family to attend college? Yes No
Have you applied for financial aid? Yes No
Are you planning to work while attending college? Yes No If yes, how many hours per week:
Goals
Major
Educational Goal: (check all that apply to you) Certificate AA/AS Degree Transfer Other
If you plan to transfer, what are you top three university choices? 1. 2. 3.
If you could choose three careers, what would they be? (Do not think about grades, skills, formal education or family resources at this time) 1. 2. 3.
If you are a student with a disability and require any accommodations, such as large print, Braille, or interpreting services, please indicate the accommodation you are requesting here: