NJCAA Eligibility Affidavit

Other Information
Parents Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents Phone Number*

Area CodePhone Number
Parent's Names*

First NameLast Name
Parent's Names

MotherFather
Foreign Born Students
Are you a US Citizen or a Permanent Resident (Holder of a Green Card or USA Passport*

YesNo
Do you have another type of VISA

YesNo
If so what type?
Do you have an I-20 Form on file at this College

YesNo

High School Information
Name of High School(s) you have attended*
City, State, Country*
Did you graduate *

YesNo
High School Graduation Date (Month/Year)*
Were you home schooled?*

YesNo
Did you graduate?*

YesNo
Check here if you have earned a *GED

Yes
GED: Date earned (Month/Year)
*A COPY of your High School Diploma or GED must be sent to the NCC Admissions Office

List the college, dates attended, and specify part of full time.

Additional Explanations-If you attended college part time or were not attending college for any period of time following high school graduation, please document your employment and military history during those times in the space below. If you were unemployed at anytime, please list those dates below. The NJCAA requires that you account for anytime you were not enrolled full-time. Please use the space below. Please record months and years when referring to dates.

I understand that information falsified or omitted can make me ineligbile for ALL furutre college competition in compliance with the NJCAA Eligibility Rules.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Personal Information