Office of Enrollment Services
Undocumented Students – Application for Acceptance – Out-of-State Tuition
Do not have 3 years attendance In a RI High School
I
f you are not a U.S. citizen, a permanent resident of the U.S., or do not have an eligible non-immigrant visa, you may qualify to
attend CCRI as an in-state resident or an out of state resident as an undocumented student.
Please submit this along with all required forms and documents. (Please use your legal last and first name)
Last Name___________________________________________________ First Name____________________________
CCRI ID _______________________________ (if available.) Cell Phone________________________________________
RESIDENCY APPLICATION CHECKLIST
Check items submitted
______ Application for Admission/Paper (if application not yet submitted)
______ High School Mid-Year Transcripts
High School seniors submit transcript, which includes mid-year senior grades.
______ Final Official High School transcript or GED® Credential or International High School
transcript evaluated and translated from approved agency. Visit: ccri.edu/oes/records/transfers/tran_info.html
NOTE: Submit your high school/GED® transcript to: [email protected] or bring an
official transcript in a sealed envelope to an Enrollment Services office on any CCRI campus.
______ Student Application form
______ Request for Student’s Taxpayer Identification Number (Substitute W9S) form
Please follow directions on the form.
NOTE:
If name on high school/GED® transcript does not match name on Application for Enrollment, please submit
One and the Same Person Affidavit (located on the last page of this packet).
Email completed packet to:
or Mail to:
CCRI Office of Enrollment Services
Residency
400 East Ave
Warwick, RI 02886-1807
1
Personal data section
• Your Social Security number and date of birth are essential in processing your application. If applying
without a Social Security number, visit: ccri.edu/oes/admissions/applicantwithoutssnortin
• If you are not a U.S. citizen, please review the application process on the CCRI Residency section located at:
ccri.edu/oes/admissions/residency.
• Questions pertaining to ethnicity and race are optional; however, answering these questions is important in
assisting the college achieve its affirmative action goals.
Programs of Study
• To review CCRI programs and pathways, please visit:
Programs of Study: ccri.edu/programs
Academic and Career Paths:
ccri.edu/pathways
Arts and Humanities
Business, Economics and Data Analytics
Communication, Media and Film
Education, Government, and Human Services
Environment and Sustainability
Health and Health Administration
Science, Technology, Engineering, and Mathematics
High school/GED history
• It is your responsibility to provide CCRI with official high school or GED transcripts. Have your high school
email your official transcripts or submit your GED transcript to [email protected].
College history
• List ALL colleges and universities previously attended and have your coursework from other colleges
evaluated. Request that official e-transcripts be sent to [email protected]
Submit your application
• Please submit your completed application to [email protected] or deliver/mail it to any CCRI campus.
• Please print one sided.
Application for Admission and Instructions
Apply online for free at ccri.edu/apply, or follow the instructions below to apply using a paper application.
Lincoln:
Warwick:
CCRI - Knight Campus
Ofce of Enrollment Services
400 East Ave.
Warwick, RI 02886
Providence:
CCRI - Liston Campus
Ofce of Enrollment Services
One Hilton St.
Providence, RI 02905
Newport:
CCRI Newport County Campus
Ofce of Enrollment Services
One John H. Chafee Blvd.
Newport, RI 02840
CCRI - Flanagan Campus
Ofce of Enrollment Services
1762 Louisquisset Pike
Lincoln, RI 02865
CCRI APPLICATION 09
/
2022
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Introduce
yourself:
Start here. Go anywhere.
90
3
APPLICATION FOR ADMISSION
Tell us about your interest in CCRI. Please share this information with us so that we can better advise you on your best course of action.
New First-time student: I am a rst-time college student. RI Promise students must select a degree program to be eligible.
Returning Student: I have a previously attended CCRI but have not attended CCRI in two or more years.
Non-Degree Student. I want to take courses for personal enrichment or am attending another college, but not pursuing a degree at CCRI.
Transfer Student. I have attended another college and want to transfer to CCRI to complete a degree.
Personal data
Previous name
Permanent home street address
Are you a U.S. citizen?
Yes
No
If you are not a U.S. citizen, do you have a Permanent Resident Card (Green Card)?
Yes
No
If you are a permanent resident card holder, please provide your alien registration number: _____________________________________________________
Have you lived continuously in Rhode Island for one or more years as of the rst day of classes for this semester?
Yes
No
Is Rhode Island your legal and permanent state of residence?
Yes
No
If you have a non-Rhode Island permanent home address and you are claiming Rhode Island residency, you must submit a CCRI Application for In-State Residency and all
required documentation. This information is available at ccri.edu/oes/admissions/pdfs/resusperm.pdf
If you are not a legal and permanent resident of Rhode Island, please list your legal residence.
Street
_______________________________________________________City _________________________________________State _______ ZIP _____________ Country____________________________
Service members or dependents
Did you serve or are you currently serving in the U.S. armed forces?
Yes
No
If you or your dependents are currently serving, are you stationed in Rhode Island on active duty?
Yes
No
Will you be using VA education benets at CCRI?
Yes
No
Please note:
• Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must submit documentation of their status.
• Other visa or immigration status: Must submit your Visa, I-797 or other documentation.
Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college, but you will remain liable for all tuition and fees.
Date of birth (mm/dd/yy)
Home telephone number
Social Security number
Cell number
Please text me important time-sensitive messages about
enrollment, financial aid and academic requirements.
Date of application
City
(legal)
Email address
State/Zip
Last name
First name
Middle initial
Middle initial
This information is requested on a voluntary basis by the U.S. Dept. of Education, National Center for Education Statistics. Your answer will not affect admission to or registration in
the college.
Are you Hispanic or Latino?
Not Hispanic
Hispanic or Latino
Choose two or more of the following races:
Are one or both parents (biological or adoptive) earned a four-year degree
Yes
No
Are you a single parent with custody of a child under 18
Yes
No
* Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education
reporting purposes. Only statistical numbers are reported. No individual data appears on the federal reports.
For Ofce Use
CCRI ID Number: For Ofce Use
If applying without a social security number see ccri.edu/oes/admissions/applicantwithoutssnortin.html
Yes
No
(legal)
Gender:
Male
Female
Non-binary
Prefer not to disclose
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other
Pacic Islander
White
CCRI APPLICATION 09
/
2022
Please print o
ne sided
4
College/University name Code City State Degree
College/University name Code City State Degree
College/University name Code City State Degree
Programs of interest: Please indicate your program choices. Please print clearly.
What program of study are you interested in pursuing?
I am interested in a degree program (if choosing General Studies, select an Academic and Career Path)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
At this time, I am interested in applying as a nondegree student
(Please note: Financial aid, including on-campus work programs, is not available to nondegree students.)
Are you interested in receiving information about the Joint Admissions Agreement (JAA) among the Community College of Rhode Island, Rhode Island College
and the University of Rhode Island?
Yes
No, thank you
Program of Study (See page 2)
Academic and Career Path (See page 1)
Year
High school history: Please complete as appropriate. Please print clearly.
I have or will have:
High school diploma
Institution name, city, state
GED
®
credential
State in which GED
®
credential was received
Home school diploma — Please submit documentation from your local school district
approving your home schooling program.
Institution name, city, state
I do not hold any of the above.
Code
Please forward a copy of your nal ofcial high school transcript or GED
®
credential to the Ofce of Enrollment Services as soon as available.
Diploma Date
Month / Day / Year
College history: Please list ALL undergraduate colleges and universities attended. (Please submit ofcial transcripts from each
school to the Ofce of Enrollment Services, 1762 Louisquisset Pike, Lincoln, RI 02865.) Please print clearly.
COLLEGE 1:
COLLEGE 3:
COLLEGE 2:
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
Agreements:
I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to abide by the rules and regulations
at, and fulll all nancial obligations to, the Community College of Rhode Island
.
Acceptance Checkbox
I understand that checking this box constitutes a legal signature conrming that I acknowledge and agree to the above Terms of Acceptance.
For Ofce Use Only
NEBHE __________________
Code
Date Received
Month / Day / Year
Code
Date Received
Month / Day / Year
Intended Entry Date
January/Spring
September/Fall
Summer
Applicant's signature Application date
Do you have a bachelor’s degree from a U.S. college or its equivalent from a school in another country?
Yes
No
If yes, indicate the degree received below.
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
_______________________________________________________________________________ ______________________________________________________ _________________ ________________________
If under age 18, signature of parent/guardian Application date
Please type your First and Last Name
CCRI APPLICATION 09/2022
Please print one sided
5
High School and College Codes
360 High School ...................................................................................400360
Academy for Career Exploration
.....................................................400146
(formerly Textron Chamber of Commerce Academy)
Alternate Learning Project.................................................................400143
Dr. Jorge Alvarez High School
..........................................................400001
Apponaug Christian Academy
...........................................................400241
Aquidneck Island Christian Academy
..............................................400129
Attleboro High School
........................................................................220073
Barrington Christian Academy..........................................................400002
Barrington High School
......................................................................400000
Beacon Charter School
......................................................................400282
Bellingham Memorial Jr.-Sr. High School
........................................220117
Bishop Connolly Regional High School
...........................................220783
Bishop Feehan High School
...............................................................220077
Bishop Hendricken High School
.......................................................400238
Bishop Keough Regional High School
.............................................400099
Blackstone Academy Charter School
..............................................400100
Blackstone-Millville Regional High School
......................................220160
Blackstone Valley Baptist Academy
.................................................400038
Blackstone Valley Prep
.........................................................................400031
Blackstone Valley Reg. Voc. Tech. High School
............................222154
Block Island High School
....................................................................400005
Burrillville High School
.......................................................................400055
Case High School
.................................................................................222105
Central Falls High School
...................................................................400012
Central High School
............................................................................400145
Chariho High School
...........................................................................400270
Classical High School
..........................................................................400150
Coventry High School.........................................................................400030
Coyle-Cassidy Memorial High School
............................................222120
Cranston High School East
................................................................400035
Cranston High School West
.............................................................400036
Cumberland High School
...................................................................400037
Davies Career and Technical High School
.....................................400057
Dighton-Rehoboth Regional High School
.....................................221645
Durfee High School
............................................................................220785
E 3 Academy
.........................................................................................400157
East Greenwich High School
........................................................... 400040
East Providence High School
........................................................... 400050
Evolutions High School
.......................................................................400172
Exeter-West Greenwich
Regional Jr.-Sr. High School .........................................................400252
Feinstein High School
..........................................................................400154
First Baptist Christian School
............................................................400242
Foxborough High School
..................................................................220840
GED
®
credentials ...................................................................................... GED
Global Learning Public Charter School...........................................221488
Greene School
......................................................................................400254
Highlander Charter School
................................................................400243
Hope High School
..............................................................................400155
Immaculate Conception Academy
...................................................400227
Johnston High School .........................................................................400058
Killingly High School
............................................................................070135
King Phillip Regional High School ....................................................222562
La Salle Academy
................................................................................400160
Lincoln High School
...........................................................................400059
Lincoln School (Providence)
............................................................400165
Manseld High School
.........................................................................221320
Masters Regional Academy
................................................................400220
The Metropolitan Regional Career
and Technical Center .....................................................................400166
Middletown High School
...................................................................400063
Milton High School
..............................................................................221440
Moses Brown School
..........................................................................400180
Mount Hope High School
(formerly Bristol High School) ...........................................................400010
Mount Pleasant High School
..............................................................400185
Mount St. Charles Academy
..............................................................400285
Narragansett High School
..................................................................400064
New England Academy of Torah (Hebrew Day)..........................400187
New England Laborers’/Cranston Public School
Construction Academy ..................................................................400034
North Attleboro High School
...........................................................221625
North Kingstown High School..........................................................400088
North Providence High School .......................................................400090
North Smitheld High School
...........................................................400287
Norton High School
............................................................................221670
Ocean Tides School
............................................................................400066
Our Lady of Fatima High School
.....................................................400236
Paul Cuffee High School
.....................................................................400006
Penn Foster
...........................................................................................394413
Pilgrim High School
.............................................................................400239
Plaineld High School
..........................................................................070090
Ponaganset High School
.....................................................................400093
Portsmouth Abbey School
.................................................................400130
Portsmouth High School
....................................................................400128
Paul J. Primavera Educational Center
...............................................220116
The Prout School
.................................................................................400228
Providence Career and Technical High School
............................400142
Providence Country Day School
....................................................400045
Rhode Island Nurses Institute Middle College
............................400141
Rhode Island School for the Deaf
....................................................400189
Rocky Hill School
.................................................................................400043
Rogers High School
.............................................................................400075
Juanita Sanchez Complex
...................................................................400183
(formerly the Providence Academy of International Studies and
William Cooley Health, Science and Technology Academy)
School One
............................................................................................400188
Scituate Jr.-Sr. High School
................................................................400095
Seekonk High School
..........................................................................221891
Shea High School (Pawtucket West)
...............................................400125
Smitheld High School
........................................................................400053
South Kingstown High School...........................................................400230
St. Andrew’s High School
.................................................................400250
St. Dunstan’s Day School
...................................................................400193
St. George’s High School
...................................................................400085
St. Mary Academy (Bay View)
...........................................................400215
St. Raphael Academy
...........................................................................400110
Taunton High School
..........................................................................222123
Times 2 Academy.................................................................................400144
Tiverton High School
..........................................................................400224
Tri-County Reg. Voc. Technical High School
................................220864
Trinity Academy for the Peforming Arts
.........................................400210
Trinity Christian Academy
.................................................................400060
Toll Gate High School.........................................................................400237
Tolman Senior High School
...............................................................400115
U.S. Naval Academy Prep School
.....................................................400068
Uxbridge High School
.........................................................................222155
Jacqueline M. Walsh School of
Performing and Visual Arts ...........................................................400969
Warren High School
...........................................................................400235
Warwick Veterans High School
.......................................................400240
West Warwick High School
..............................................................400265
Westerly High School
.........................................................................400255
The Wheeler School
...........................................................................400170
Woonsocket High School
..................................................................400295
Home School
........................................................................................ HOME
Other
......................................................................................................409555
Out-of-Country
....................................................................................409777
Out-of-State (if not listed above)
........................................................409888
COLLEGE CODES
Bridgewater State University ................................................................. 3517
Bristol Community College
.................................................................. 3110
Bryant University
..................................................................................... 3095
Community College of Rhode Island
.................................................. 3733
Dean College
............................................................................................ 3352
Fisher College
........................................................................................... 3391
Johnson & Wales University
.................................................................. 3465
New England Institute of Technology
................................................. 0339
Providence College
.................................................................................. 3693
Rhode Island College
.............................................................................. 3724
Roger Williams University
..................................................................... 3729
Salve Regina University
.......................................................................... 3759
University of Massachusetts-Dartmouth
............................................ 3786
University of Rhode Island .................................................................... 3919
CCRI APPLICATION 09/2022
Please print o
ne sided
COMMUNITY
COLLEGE
OF
RHODE
ISLAND
Eligibility for
In-State Tuition
and Fees
Based Upon Rhode Island High
School Attendance
Student
Application
(To
be
completed
by
Student)
N
AME
:
CCRI
S
TUDENT
ID
#
IF
AVAILABLE
:
A
GE
:
D
ATE OF
B
IRTH
:
Gender:
Male Female
P
LACE OF
B
IRTH
:
C
ITY
:
S
TATE
:
C
OUNTRY
:
C
URRENT
S
TREET
A
DDRESS
:
C
ITY
:
S
TATE
:
Z
IP
C
ODE
:
T
ELEPHONE
:
C
ELL
:
E
MAIL
:
H
IGH
S
CHOOL
OR
GED
I
NFORMATION
(
PROVIDE
INFORMATION
ON
ALL
SCHOOL
[
S
]
YOU
ATTENDED
IN
GRADES
9-12)
S
CHOOL
N
AME
C
ITY
S
TATE
F
ROM
(
MONTH
/
YEAR
)
--
T
O
(
MONTH
/
YEAR
)
For
office
use
only
CCRI STUDENT ID #: Comments:
Received:
Decision Date:
Year:
Term
Code:
Signature:
Instructions
Purpose. The Community College of Rhode Island (CCRI) must get your correct identifying
number to file Form 1098-T, Tuition Statement, with the IRS and to furnish a statement to you.
This will be your Social Security number (SSN) or, if you are not eligible to obtain an SSN, your
individual taxpayer identification number (ITIN). Form 1098-T contains information about
qualified tuition and related expenses to help determine whether you, or the person who can
claim you as a dependent, may take either the tuition and fees deduction or claim an education
credit to reduce Federal income tax. For more information, see IRS Pub. 970, Tax Benefits for
Higher Education.
Under federal law, you are required to provide the requested formation.
Part I.
Enter your name and mailing address. The name should match that used by the Social
Security Administration or Internal Revenue Service.
Taxpayer identification number. Enter your SSN or ITIN. If you do not have an SSN or ITIN,
apply for one and fill out and return this form when you receive it.
Part II.
Sign your name in the space provided to confirm the information provided. The Office of
Enrollment Services cannot change your records without your signature.
Part III.
Please fill out this part only if you are unwilling or unable to provide a taxpayer identification
number. Check either the first or the second box and sign the statement. By law, CCRI must
ask you at least once a year for your taxpayer identification number in order to meet its
obligation to file Form 1098-T.
Deliver or mail the completed form to the address provided. Do not email the form. Email
is not a secure way to transmit personal information.
Penalties
Failure to furnish correct SSN. If you fail to furnish your correct SSN or ITIN to CCRI, the IRS
may impose a penalty of $50 unless your failure is due to reasonable cause and not to willful
neglect.
Misuse of SSNs. If CCRI discloses or uses your SSN in violation of Federal law, CCRI
may be
subject to civil and criminal penalties.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to give your correct SSN or ITIN to
persons who must file information returns with the IRS to report certain information. The IRS
uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal
litigation and to cities and states to carry out their tax laws.
October
2014
National Association of College
and Business Officers
Returncompletedsignedform,inpersonorbymail,to:
CommunityCollegeofRhodeIsland
OfficeofEnrollmentServices
400EastAvenue
Warwick,RI02886
NameofStudent
Address
PARTI
Icertifythatthenumbershownonthisformismycorrecttaxpayeridentificationnumber.
PARTII
OR
Iamaforeignnational/nonresidentalienanddonothaveaSocialSecuritynumberor
individualtaxpayeridentificationnumber.
IdonotplantofileanincometaxreturnintheU.S.
IdonotwishtoprovidemytaxpayeridentificationnumbertoCCRIatthistime.
PARTIII IunderstandthatImaybesubjecttoanIRSfineof$50forfailuretodoso.
IfurtherunderstandthattheIRSwillnotbeabletousetheForm1098‐TfiledbyCCRI
toconfirmmyeligibilityforcertaineducationtaxbenefitswithoutmytaxpayer
identificationnumber.
TaxpayerIdentificationNumber
RequestforStudent’sTaxpayerIdentificationNumber
(SubstituteFormW‐9S)
Signature Date
DateSignature
(SSNorITIN)
_________‐______‐____________ ___________________________
Donotsubmit
thisformtotheIRS
CCRIBannerID
Office of Enrollment Services
COMMUNITY COLLEGE OF RHODE ISLAND
One and the Same Person
Affidavit
(To be completed by student, signed in the presence of a Notary Public,
and submitted to the Office of Enrollment Services – Knight Campus, Warwick)
I, the undersigned under oath, depose and say as follows:
(a) That I have personal knowledge of the facts stated herein, which are all true, correct, and
complete; and
(b) That I have been and/or am known by the following names:
Name at birth
Name recorded in school ; and
(c) That the names set out in section (b) above are one and the same person.
Name (please print your name)
Signature Date
CCRI Student Identification # Student Date of Birth
STATE OF RHODE ISLAND
COUNTY OF_________________
This Affidavit has been subscribed and sworn to before me on this ________ day of , 20 _____.
Notary Public of the State of Rhode Island
My Commission Expires:
Stamp:
12/2021
