DUAL CREDIT APPLICATION FOR ADMISSION

Non-discrimination statement: Non-Discrimination Statement

Personal Information

Enter your full legal, last, first, and middle name. Do not use nicknames or abbreviations.  Use your full legal name on all documents sent to PJC.  Please do not include diacritical marks such as accents or tildes.

First Name:

Last Name:

Middle Name:

Suffix:

Preferred Name:

Date of Birth: (MM/DD/YYYY)

Social Security Number: *

(Required for US Citizens)

Citizenship Information

Are you a U.S. Citizen?

Of what Country are you a Citizen?

Do you hold Permanent Residence status (valid I-551) for the U.S.?

Please provide your Resident Number:

Date Permanent Resident card issued:

Please submit a copy of both sides of the card to the Records Office at admissions@parisjc.edu

Do you have an application for permanent residence (Form I-485) pending with the U.S. Citizenship and Immigration Services (USCIS)?

Submit a copy of your Notice of Action from the USCIS form I-797C to the Records Office at admissions@parisjc.edu as this could affect your tuition.

If you have an individual Taxpayer Identification Number (ITIN) and do not have a Social Security Number filled in above, please enter it below. Otherwise please leave this blank.

Did you live or will you have lived in Texas for 36 consecutive months leading up to High School graduation or completion of the GED?

Please submit a completed Affidavit of Intent to Become a Permanent Resident to the Records Office at admissions@parisjc.edu as this could affect your tuition.

Please submit a copy of your Notice of Action from the USCIS form I-797C or a copy of your current Visa to the Records Office at admissions@parisjc.edu as this could affect your tuition.

Are you a foreign national here with a visa that makes you eligible to domicile for Texas residence purposes or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status?

Indicate which visa type applies:

Please submit a copy of your Notice of Action from the USCIS form I-797C or a copy of your current Visa to the Records Office at admissions@parisjc.edu as this could affect your tuition.

Please provide your Permanent Address

Physical Address:

Apt or Suite Number:

City:

State:

Zip:

(*Required, Format: 12345 OR 12345-6789 OR A1B 2C3)

Country:

County:

Do you have a different mailing address?

Please provide your Mailing Address

Mailing Address:

Apt or Suite Number:

City:

Zip:

(*Required, Format: 12345 OR 12345-6789 OR A1B 2C3)

State:

Country:

County:

Cell Phone Number:

May we text?

PJC corresponds important information through email, please provide an address that is checked frequently (Please do not use High School email address). 

Personal Email Address:

Confirm Personal Email Address:

High School Information

Enrollment Classification:

What is your current grade level?

What is your primary reason for attending PJC:

My High School is?

I will graduate from high school on:

(Ex. 05/2026)

First Generation College Student

Race Information

Ethnicity:

Race:

Gender

Gender:

Residency:

Are you a Texas resident?

Have you lived in Texas for 12 months?

Do you attend a Texas Public School?

Have you lived in your current address for 12 months?

If no, what was your previous address:

Candidacy Information

Anticipated Year of Enrollment:

Anticipated Term of Enrollment:

Degree:

Emergency Contact

First Name:

Last Name:

Cell Phone Number:

Physical Address:

Apt or Suite Number:

City:

State:

Zip Code:

DC APPLICATION - Certification

PJC has permission to access my Texas Success Initiative (TSI) scores on-line if necessary and I acknowledge that information concerning Bacterial Meningitis, Student Code of Conduct and FERPA can be found in the Student Handbook, the catalog and on the PJC website at www.parisjc.edu.

I authorize Paris Junior College to review my transcripts from another Texas higher education institution to determine my eligibility for an associate degree, to award the degree where requirements are complete, and to notify me of the results. 

Paris Junior College must obtain 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 a 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. 

Paris Junior College has an open door admission policy and does not discriminate on the basis of race, creed, gender, national origin, age or disability in its educational programs, activities, employment, or admission policies. 

Certification of Residency, by agreeing to this statement, I understand that officials of my college/university will use the information submitted on this form to determine my status for residency eligibility. I authorize the college/university to verify the information I have provided . I agree to notify the proper officials of the institution of any changes in the information provided. I certify that the information on this application is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.