* = Required Field

This application is only intended for DEGREE-SEEKING applicants. If you previously submitted an
application within the past two years and simply need to update your information, do not reapply.
Please contact the CSN Call Center at 702-651-5555. If you are not seeking an associate degree
or certificate of achievement from the College of Southern Nevada, please STOP and return to our
application page .

APPLICATION SUBMISSION REQUIREMENTS:

Complete all sections of the application.
Providing your social security number is optional. A social security number is required when
applying for federal financial aid assistance, some scholarships, and by the IRS for the 1098
tax credit. You will may experience a delay in receiving aid if you do not supply your social
security number and high school credentials on this admissions application.

AFTER APPLICATION SUBMISSION:

Allow 4-5 business days to process your application. Once processed, your admission letter and
account validation instructions will be emailed to you. Make sure to check your junk mail/spam
folder if you don’t see these emails in your inbox. After 4-5 business days, contact the Office of the
Registrar at (702) 651-5610 or admrec@csn.edu .

APPLICATION COMPLETION TIPS:

As you complete each section, please click on the SAVE button.
You can begin working on the application and choose SAVE & RETURN LATER .
NOTE: You will NOT be able to edit your application once you click on the SUBMIT button.
* = Required Field

Anticipated Term & Year of Enrollment

Spring (January - May)
Summer (May - August)
Fall (August - December)

* Fall 2022 * What is your preferred campus? Western Learning Center

Term

My Personal Information

Prefix * Legal First Name Middle Name * Legal Last Name Suffix
Mr. Amier Affandi
Former/Maiden Name
(If you attended any NSHE institution in the past or submitted documents under another name, this will help us to match your file.)
Former First Name Middle Name Former Last Name

* Date of Birth Gender

08/08/1989 Male
[mm/dd/yyyy]
(Enrollment of profoundly gifted and talented minors under 16 years of age is on a case-by-case basis upon the approval of
institutional officials. Please contact the Office of the Registrar to proceed with a request for admissions. Do not proceed with this
application)
Social Security Number or Tax Identification Number
xxxxxxxxxx
XXX-XX-XXXX

Furnishing this information is optional. A social security number is required for federal financial assistance, some scholarships, and
by the IRS for the 1098 tax credit.
* Are you a Nevada foster youth or were you, at any time, in the Nevada foster care system?
No
Students who have been in Nevada foster care may be eligible for additional resources and/or support services. In some cases, this may include a
course enrollment fee/tuition waiver.

My Contact Information

* Address Line 1
4410 Mesa Drive

Address Line 2

* City
North Las Vegas

* State * Postal Code * Country

NV 89032 United States of America

Check if the physical address is NOT the same as the mailing address.
[ X]

* Phone Number * Phone Type * Ok to send text messages?

702 - 418 - 2815 Cell/Mobile Yes

* Email Address
supernocan@gmail.com
The Nevada System of Higher Education does not rent or sell e-mail addresses to anyone.

My Former Address

Address Line 1

Address Line 2

City

State Postal Code Country

My Parent or Guardian Education

Please choose the highest level of education completed by parent or guardian.

Middle School/Junior High

My Race and Ethnicity

[X] Check if you are Hispanic or Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish
culture origin, regardless of race).

Racial Category
Select the racial category or categories with which you most closely identify by checking as many categories that apply.
American Indian or Alaskan Native
[ X]

Asian
[ X]

Black or African American

[ X]

Native Hawaiian or Pacific Islander

[ X]

White
[ X]

My Citizenship and Residency

Providing your citizenship status is optional, however your residency classification could be impacted.

Are you an U.S. citizen?

Yes

* Do you currently live in Nevada?

Yes
Notification of residency status will be included in your admissions letter. For additional residency information, please visit
www.csn.edu/residency .

* Date you began living in Nevada?

01/15/2001
[mm/dd/yyyy]

Employment

Is your degree at CSN sponsored by your current employer?

No

Veteran Information

I am a former member of the US Armed Forces.

No

I am a dependent of a member of the US Armed Forces.

No
 * = Required Field

My High School Education

* Please choose one:

I will graduate from high school prior to my first term of enrollment

My High School Information

* Name of high school

Unknown HS Georgia
Enter full high school name. If not listed, type 'Unknown HS' with State or Country. Ex. 'Unknown HS
Alabama'.

City State
These fields are populated by our system. GA
If they are blank please continue with the application.

* Date of graduation/GED/HSE or expected graduation from high school: (MM/YYYY)

07/2022
[mm/yyyy]

Nevada Millennium Scholar Information

Millennium Scholar ID (if known)

For additional Millennium Scholarship information, please visit www.nevadatreasurer.gov/GGMS/Students/ .

NSHE ID
If you have been accepted, previously attended or are currently attending a Nevada System of Higher Education (NSHE) institution,
please provide the ID assigned to you by that institution in the space below. NSHE institutions include: CSN, GBC, NSC, TMCC,
UNLV, UNR, WNC.

Nevada Promise

[X] I have applied or will apply for the Nevada Promise Scholarship.

CSN's Division of Workforce and Economic Development (DWED) or Adult Career and Education Services (ACES)

Have you completed a non-credit class or certification through CSN’s Division of Workforce and Economic Development (DWED)
or Adult Career and Education Services (ACES)?
No

Are you applying to CSN upon referral from EmployNV Career Hub?
No

My Previous College/University Education

Please list every college or university you have attended. This includes institutions within Nevada, out of state and outside the
United States. If you have earned more than one degree from the same institution, please list the highest degree awarded. To add
more institutions, select ' Add Another Response '.

* Name of Institution
Enter full college name. If not listed, type 'Unknown College' with State or Country. Ex. 'Unknown College
Albania'.

Degree

Start Date To Date Degree Date

[mm/dd/yyyy] [mm/dd/yyyy] [mm/dd/yyyy]

* = Required Field

My Education Objective

* Areas of Study
Art & Design

Art & Design

Leads to careers in art, music, theatre, graphic and web design, photography, and videography and film.

* = Required Field

Declarations

*
[X] I am responsible for requesting other institution(s) to send my official transcripts to CSN’s Office of the Registrar for transferred
credit evaluation and/or CLEP consideration.

*
[X] I certify that the information provided on this application is true and accurate to the best of my knowledge.

* I agree to maintain accurate mailing, email, and phone contact information, and to pay all amounts due by published deadlines.
[X] If my account becomes delinquent, I understand the account will be placed on hold and may be forwarded to a collection
agency. I acknowledge that I am responsible for all associated costs of collecting any past due amounts.

Disclaimers

You are applying to an institution that is a member of the Nevada System of Higher Education (NSHE) and will be issued one
identification number to be used at all NSHE institutions. Limited personal information is shared among NSHE institutions in
accordance with NSHE policies governing the security and privacy of student and employee information.

CSN is an Equal Employment Opportunity/Affirmative Action institution and does not discriminate on the basis of sex, age, race,
color, religion, disability, national origin, veteran status, sexual orientation, genetic information, gender identity, or gender expression
in the programs or activities which it operates. For more information, visit www.csn.edu/nondiscrimination .

Student Signature

* Electronic Signature * Date

Amier Affandi 08/08/1989
[mm/dd/yyyy]

* I certify I am 18 years of age or older.

Yes