JEVS/Peirce College Application

Program of Interest

CER

AS or BS

AS or BS or CER

BS or CER

Business Concentration

IT Concentration

Personal Information

First Name

Middle Initial (optional)

Last Name

Phone

Country

Street Address

City

State

State / Province

ZIP / Postal Code

SSN

If you or your parent or spouse works for or is a member of one of the below organizations, you may be eligible for a tuition discount after completing a verification process.

Demographic Information

Gender

Date of Birth (MM/DD/YYYY)

Country of Citizenship

Contact Information

American Indian or Alaska Native	Asian
Black or African American	Native Hawaiian or Other Pacific Islander
White	Two or more races