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Jefferson Community College Website
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EOP Interest Form
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Contact Information
First Name
Preferred Name
Last Name
Email Address
Cell Phone Number
Birthdate
Birthdate
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Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Are you a New York State Resident?
Yes
No
How long have you been a NYS resident? (Years/Months)
Student Information
Household Size
1
2
3
4
5
6
7
8
9
10
Estimated Household Income
$0 - $30,000
$30,001 - $50,000
$50,001 - $70,000
$70,001 - $100,000
$100,000+
Are you a current HS student?
Yes
No
High School Name
School Counselor Name
HS Graduation Year
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Are you a current college student?
Yes
No
Current Institution Name
CEEB Code
Are you currently in EOP/HEOP/SEEK?
Yes
No
Have you previously attended JCC? (not EDGE)
Yes
No
Have you previously attended another college?
Yes
No
Military Affiliation
Active Duty
Active Duty Dependent
Active Duty Spouse
Veteran
Veteran Dependent
Veteran Spouse
US Reserves / National Guard
None
Jefferson Information
Entry Term
Fall 2024
Major
Undecided / Unsure
Accounting A.A.S.
Accounting A.S.
Accounting Certificate
Agri-Business A.A.S.
Allied Health & Biological Sciences Concentration, Natural Sciences A.S. Liberal Arts & Sciences
Business Administration A.A.S.
Business Administration A.S.
Business Administration A.S./B.S. (joint w/ SUNY Potsdam)
Chemical Dependency A.A.S.
Chemical Dependency Certificate
Childhood Education A.A., Liberal Arts & Sciences
Childhood Education A.A./B.A., Liberal Arts & Sciences (joint w/ SUNY Potsdam)
Computer Information Systems A.S.
Computer Information Technology A.A.S.
Computer Science A.S.
Creative Writing Concentration, Humanities & Social Sciences A.A., Liberal Arts & Sciences
Criminal Justice A.S.
Criminal Justice Certificate
Culinary Arts Concentration, Hospitality & Tourism A.A.S.
Early Childhood A.A.S.
Early Childhood A.S.
Early Childhood Certificate
Engineering Science A.S.
Fire Protection Technology A.A.S.
Fire Protection Technology Certificate
Health Care Management
Homeland Security A.S.
Hospitality & Tourism Certificate
Hotel/Restaurant Management Concentration, Hospitality & Tourism A.A.S.
Human Services A.S.
Humanities & Social Sciences A.A., Liberal Arts & Sciences
Individual Studies A.A.
Individual Studies A.A.S.
Individual Studies A.S.
Literature Concentration, Humanities & Social Sciences A.A., Liberal Arts & Sciences
Mathematics A.S.
Nursing A.A.S.
Office Studies Certificate
Office Technologies - Administrative Assistant A.A.S.
Office Technologies - Medical A.A.S.
Paralegal A.A.S.
Physical Education A.S.
Physical Science Concentration, Natural Sciences A.S., Liberal Arts & Sciences
Psychology Concentration, Humanities & Social Sciences A.A., Liberal Arts & Sciences
Sports Management A.S.
Teaching Assistant Certificate
Winery Management & Marketing Certificate
Winery Management & Marketing Concentration, Hospitality & Tourism A.A.S.
Zoo Technology A.A.S.
Other / Not Listed
Specify your program:
Please identify your career goal
Have you applied to JCC?
Yes
No
JCC Student ID
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