Student Information Sheet
Date__________________
Name of Student______________________________________________
First, Last, and/or Other Names on Transcripts______________________
Social Security Number:_____-_____-_____
Address:____________________________________________________________
City_________________State______Zip Code__________
Home Telephone: (___)-_____-_____
Work Telephone: (___)-_____-_____
E-Mail Address: _________________
Check The Programs You Are Interested In:
_____ Early Childhood Education Associate of Science
_____ Early Childhood Education Certificate of Completion
_____ Diversity Issues ECE Certificate of Completion
_____ Infant/Toddler Development Certificate of Completion
_____ School-Age Care Certificate of Completion
Mail To: SBCC ECE Department 721 Cliff Drive SB 93109
