Virginia Western Community College

Application For Admission

Prefix

Mrs.

First Name

Terrell L.

Middle Name
Last Name

Hawks

Suffix
SSN

695012112

Former First Name

Former Middle Name
Former Last Name
Date of Birth

11/29/1989

College

Virginia Western Community

College

Campus

Main

Class Type

CRED

Term

2016 Summer between

05/16/2016 and 07/27/2016

Plan

Develop Job Skills (022)

Previous Student or Employee

Emplid

6968560

Primary Phone

703-216-1534

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Street Address 1

1609 Lawman Avenue

Chantilly, VA 22021

Street Address 2
City

Chantilly

State

VA

Postal Code

22021

Country

United States

Current Residence

VIRGINIA BEACH

Have you lived in Virginia the past twelve

months?

Email

nilofy.com@gmail.com

Student's Employer (If Employed)

Business Phone

--

Emergency Contact First Name

Emergency Contact Last Name
Emergency Contact Relationship
Emergency Contact Phone
Ethnicity
Gender

Male

English is Primary Language

Military Status

Spouse

Citizenship Status

Naturalized

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Level of high school education

Home School (graduated or

currently enrolled)

Home School State

Virginia

Home School Graduation Date

Aug 2010

Father's Highest Education

Do Not Know

Mother's Highest Education

Do Not Know

Are you a U.S. citizen?

Yes

What is your military status?

Have never served in the U.S.

military

Whose domicile do you want to use to claim

eligibility?

My own domicile

Have you lived in Virginia for the last twelve

months?

Yes

For last year you:

paid Virginia income taxes on

all earned income

For the last twelve months, have you held a

Virginia driver's license or Virginia DMV ID?

No

For the last twelve months, have you held a

driver's license or DMV ID in any other state?

No

For the last twelve months, have you owned or

operated a motor vehicle registered in Virginia?

Yes

For the last twelve months, have you been

registered to vote in Virginia?

Yes

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Application Confirmation
Name

Terrell L. Hawks

Date Submitted

02/26/2016

Emplid

6968560

Username

th2373

Tuition Information

Based on the residency

information you supplied, you
will receive in-state tuition rates.

Assigned Plan

Develop Job Skills (022)

Administrative Contact

Admissions Office

Phone

540-857-7231

Admissions Website

http://www.virginiawestern.edu/
admissions/newstudents.php

The signature of a parent or guardian is required for applicants under the age of
18.

Parent/guardian signature: ________________________________________

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