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                                    Information Worksheet
                                    Former LLCC students do not need to submit this form unless address, phone, major or
                                    academic history has changed since last enrollment.

Return completed
form to:

LLCC Office
of Admissions
5250 Shepherd Road
P.O. Box 19256
Springfield, IL 62794-9256

Thank you for choosing
Lincoln Land Community
College. Lincoln Land
Community College is an
equal opportunity educator
and employer.

Lincoln Land Community
College commits to not
discriminating against any
student, employee, or
prospective employee on
the basis of race, sex, age,
disability, creed, marital
status, national origin,
political affiliation or sexual
orientation. Any violations of
this policy should be
reported to the Equal
Opportunity Compliance
Officer, Human Resources,
Menard Hall, 217-786-2259.

Roger Rutherford, Chairman
Andy Ramage, Vice Chairman
Gordon A. Smith, Ed.D., Secretary
Daniel Austin
Cinda Edwards
Kent Gray
Carl Oblinger, Ph.D.
Lincoln Land Community College                                                                                                                                   res.

Admissions Information Worksheet
Former LLCC students do not need to submit this form unless address, phone, major or academic history has changed since last enrollment.                         oper.

Planned term of entry: Fall ____ Spring ____ Summer ____

Complete legal name: Last______________________________________ First______________________________________ M.I.                                             ____________

Complete legal permanent address:
street address, apt or P.O. box number ________________________________________________________________________________________

Zip:_______________ City:___________________________________ State:_________________ County: ________________________________

How long have you lived at the above address? ___________________ E-mail address:_________________________________________________

Phone: ___________________________________________home/cell/business (Please circle one)

Social security number: _____________/_______/____________                                Birth date (numbers please) _________/_______/________ K Male          K Female
(Note: Your SSN is protected under FERPA, Federal Guidelines and will not be released.)

K U. S. Citizen       or      K Resident Alien              K Work Visa, valid until ______              K Tourist Visa, valid until ______

K F-1 Student Visa, issued through ____________________ K Other Visa: _________________ Is English your primary language? K Yes                                          K No

High school attended/attending:___________________________________________________________ Anticipated or actual H.S. grad. year______

Ethnic origin, please check one:
K Asian or Pacific Islander - 01                                  K Hispanic-American - 04                                   K Prefer not to indicate - 08
K American Indian or Alaskan Native - 02                          K White American, non-Hispanic - 06
K African-American - 03                                           K Nonresident alien - 07
Program/field of study. See “program guide,” select from listings on the following pages and write program code here:_______________ example: AS.ACCT
Note: Students still in high school (pre-college) for another 1-2 years must list “undeclared” as major

Educational goals, please circle one:

1. To prepare for transfer to a college or university.                                           4. To prepare for the GED test or improve my basic academic skills.
2. To improve skills for my present job.                                                         5. For personal interest/self-development, not career-oriented.
3. To prepare for a future job immediately after attending LLCC.                                 6. Other

Certificate, degree objective, please check one: _____Course(s) only _____Complete a certificate _____Complete an associate degree

Admission status, please circle one:

1. First time college                                             3. Transfer to LLCC: previously attended another college   6. Moved to college level from other
2. New, pre-college (still in high school                         4. New general studies                                     7. Returning to LLCC - not enrolled last term
   another 1-3 years)                                             5. Continuing - enrolled at LLCC last term

Indicate highest degree earned, please circle one:
1. HS diploma                               4. Certificate                                7. Master’s                        10. None
2. GED, date ________                       5. Associate                                  8. Doctorate                       11. Still in high school
3. Some college                             6. Baccalaureate                              9. Other                               (See Special Admissions)

Has either of your parents attended college? K Yes K No
Has either of your parents completed a four-year (bachelor’s) degree? K Yes K No
Military status, please check one: K Active K Guard/Reserve K Veteran

Have you ever been expelled or dismissed from any post-secondary institution for behavioral
or disciplinary reasons? _____No _____Yes/Institution____________________________________________________________ Year__________

I understand that withholding information requested on this worksheet or giving false information may make me ineligible for admission to the college or subject
to dismissal. I certify that the above statements are correct and complete. I agree to abide by the rules and regulations of Lincoln Land Community College.

Signature ___________________________________________________ Date _______________________________________________________

Applicant under 18 parent/guardian signature required ________________________________________ Date ______________________________

Associate in Arts (AA), Associate in Science (AS), or Associate in Arts in Teaching (AAT) Degree (Transfer)
Accounting - AS.ACCT                        Early Childhood Education - AA.ECHED     Law Enforcement - AA.LAW                 Political Science - AA.POSC
Agriculture - AS.AGRI                       Early Childhood Education - AAT.ECE      Liberal Arts - AA.LBA                    Psychology - AA.PSYC
Architecture - AA.ARCH                      Economics - AS.ECON                      Liberal Arts - AS.LBA                    Secondary Education - AA.SECED
Art - AA.ART                                Elementary Education - AA.ELED           Literature - AA.LIT                      Sociology - AA.SOCL
Biology - AS.BIOL                           Foreign Language - AA.FORL               Mathematics - AS.MATH                    Special Education - AAT.SPCED
Business Administration - AS.BUSAD          Pre-Forensic Science - AS.PFSCI          Pre-Medical - AS.PMED                    Speech - AA.SPCH
Chemistry and Chemical                      Geo Sciences - AS.GEOSC                  Pre-Clinical Lab Science - AS.MEDT       Theatre - AA.THEA
    Engineering - AS.CHEM                   Graphic Design - AA.GRDSN                Music - AA.MUSC                          Pre-Veterinary - AS.PVET
Communications - AA.COM                     History - AA.HIST                        Pre-Pharmacy - AS.PPHAR                  Women’s Studies - AA.WMST
Computer Science - AS.CSCI                  Interpreter Training - AA.INTP           Philosophy - AA.PHIL
Criminal Justice - AA.CRJ                   Journalism - AA.JRNL                     Physical Education - AS.PHED
Pre-Dental - AS.PDEN                        Pre-Law - AA.PLAW                        Physics - AS.PHYS

   THE PROGRAMS LISTED                                     Associate in Fine Arts (AFA) or an Associate in Engineering Science
                                                           (AES) Degree (Transfer)
   ADMISSIONS                                              Associate in Engineering Science - AES.ENGR
                                                           Associate in Fine Arts – Art - AFA.ART
                                                           Associate in Fine Arts – Music Performance - AFA.MUSIC
   Please contact an Academic
   Advisor for information or refer to                     Allied Health Programs (Career and Technical)
   the current LLCC catalog.                               Associate Degree Nursing - AGE.PHLT1
                                                           Occupational Therapy Assistant - AGE.PHLT2
                                                           Associate Degree Radiography - AGE.PHLT3
                                                           Practical Nurse - CA.PHLT
                                                           Electroneurodiagnostics - AGE.END
                                                           Respiratory Care - AGE.RCP
                                                           Nursing - AS.PNUR

Associate in Applied Science (AAS) Degree (Career and Technical)
Accounting - AAS.ACCT                                       Computer InformationSystems/Programming - AAS.CISPR      Medical Office Assistant - AAS.MOA
Administrative Assistant/Office Professional - AAS.ADMIN    Construction Occupations - AAS.CONST                     Microcomputer Applications and Systems -
Agri-Business Management - AAS.AGBUS                        Customized Applied Technology - AAS.CAPTC                  AAS.MSYS
Airframe and Powerplant Aviation Mechanics -                Early Childhood Education - AAS.CHDV                     Microcomputer Programming - AAS.MPRG
    AAS.AMECH                                               Electrical Distribution Lineman - AAS.EDLM               Networking Administration - AAS.NTWA
Architectural and Construction Technology - AAS.ACT         Electronics Technology - AAS.ETEC                        Networking Techniacian - AAS.NWT
Auto Body Technology - AAS.ABODT                            Fire Science Technology - AAS.FISCI                      Paraprofessional Education - AAS.PARED
Automotive Technology - AAS.ATEC                            Graphic Design Technology - AAS. GRDST                   Precision Agronomy - AAS.AGFER
Aviation Management - AAS.AMGMT                             Hospitality Management and Services - AAS.HMS            Social and Criminal Justice -AAS.SCJ
Business - AAS.BMGT                                         Landscape Design/Turf Management - AAS.LDTM              Structural Steel Detailing - AAS.STRSL
Commercial Electrical Maintenance - AAS.CEM                 Law Enforcement - AAS.LAW
Computer Information Systems/Networking - AAS.CISNT         Legal Office Assistant - AAS.LOA

Associate in General Education (AGE) Degree (Non-Transferable)
Liberal Arts - AGE.LBA

Certificate of Achievement (more than 30 hours) (Career and Technical)
Architecture and Construction - CA.ARTCN                    Culinary Arts - CA.FDBV                                  Medical Coding Specialist - CA.CODE
Automotive Technician - CA.AUT                              Electrical Distribution Lineman Maintenance - CA.EDLMM   Networking Technician - CA.NWT
Aviation Airframe Technician - CA.ATECH                     Electronics Technology - CA.ETEC                         Web Authoring and Design - CA.WEB
Aviation Powerplant Technician - CA.PPTCH                   Emergency Medical Technician - Paramedic - CA.EMTP       Welding Specialist - CA.WELSP
Child Development Aide - CA.CDV                             Entrepreneurship - CA.ENTPR
Construction Occupations - CA.CONST                         Lodging Management - CA.HMMGT

                                                                                                    PROGRAM GUIDE (continued on back)
PROGRAM GUIDE (continued)
Certificate of Completion (30 hours or fewer) (Career and Technical)
Applied Security Practices - CC.SECU               Fire Investigator - CC.FRINV                             Microcomputer Applications and Systems - CC.MSYS
Auto Body Repair - CC.ABOD                         Fire Prevention Principles - CC.FRPRV                    Microcomputer Programming - CC.MPRG
Baking and Pastry - CC.PSTRY                       Fire Service Instructor I - CC.FINI                      Networking Administration - CC.NTWA
Basic Computer Applications Skills - CC.BCAS       Fire Service Instructor II- CC.FINII                     Office Aide/Office Assistant - CC.OAOA
Basic Nurse Assistant - CC.CNA                     Fire Tactics and Strategy I - CC.FTACT                   Office Support Specialist - CC.OSS
CAD Technician - CC.CADT                           Haz. Materials for the First Responder - CC.HAZMT        Real Estate Broker - CC.RLSTB
Certified Firefighter II - CC.FRFT                 Heating, Ventilation, Air Conditioning, and              Real Estate Salesperson- CC.RLSTS
Certified Firefighter III - CC.CFIII                 Refrigeration - CC.ACRH                                Rescue Confined Space - CC.RSCCS
Certified Warehouse and Dist. Specialist - CWHDS   Help Desk I - CC.HPDKI                                   Rescue Specialist-Vertical Level I - CC.RSCSP
Cisco Network Administration Training - CC.CISCO   Help Desk II - CC.HPDK                                   Security Cert. Network Architect - CC.SCP
Commercial Electrical Maintenance - CC.CEM         Internet Programming - CC.INPG                           Structural Collapse Operations - CC.STRCL
Community Police Officer - CC.CPO                  Juvenile Firesetter Intervention Specialist - CC.JUVFS   Technical Rescue Awareness - CC.TCRSC
Computer Programming - CC.COMP                     Landscape Design/Turf Mgmt.- CC.LDTM                     Truck Driver Training CDL Basic - CC.TDSB
Computer Technician Specialist - CC.CTECS          Leadership - CC.SUMA                                     Vehicle/Machinery Operations - CC.RDSP
Criminal Justice Studies - CC.CRJT                 Legal Office Assistant - CC.LOA                          Welding Operator - CC.WEOP
E-Business - CC.EBUS                               Management - CC.BGMT                                     Welding Specialist - CC.WELSP
Emergency Medical Technician- Basic - CC.EMTB      Medical Office Assistant - CC.MOA                        Word Processing/Graphics Specialist - CC.WPGS
Fire Apparatus Engineer - CC.FRAPE                 Medical Transcription - CC.MEDTR

Certificate of Personal Development (Career and Technical)
Personal Development - CC.PDEV

Undeclared Program - UNDECLARED Please note: “Undeclared” may make you ineligible for financial aid and the
tuition tax credit (TR-97). Please consult your tax preparer for details and guidelines appropriate for you.

College Knowledge
If you plan to work toward a certificate or degree, ask your high school and any colleges you may have attended to send your final, end-of-year
transcripts to the LLCC Admissions Office. Students needing financial assistance should apply as early as possible each year after January 1. If
you need financial aid, visit the Financial Aid Office in Menard Hall or call 786-2237 to obtain the necessary application forms. The process
takes several weeks, so be sure to apply for aid as soon as possible.
Home Schooled Students: Home schooled students interested ina single course to a degree are welcomed at Lincoln Land Community
College. Home schooled students follow the admissions, placement, advising and enrollment procedures as all new students. Transcript
records of home schooling are accepted. To insure accurate transcript evaluation, the student may be asked to meet with a Student Records
Evaluator to review subject matter and course content.
Placement Testing: New degree/certificate seeking students may need assessment for proper course placement. Call 786-2211 for information.
Academic Advisement and Career Counseling: The Student Services Center helps students explore career opportunities and select
courses required to complete programs of choice. Academic advising is also available at all regional centers.
SOAR — Student Orientation Advising Registration: Prior to enrolling, degree-seeking students new to LLCC and transfer students
with less than 15 credit hours need to complete a PC based orientation. This informational orientation to college services and procedures is
available at all LLCC locations.
Purchase Textbooks: Required and optional textbooks and supplies are available in the LLCC Bookstore or the regional centers. Most
textbooks are available three to four weeks before the term begins. Or, order online at For information, call 786-2300.

Students aged 16-18 who have not yet graduated high school or achieved a GED and wish to enroll in college credit courses may do so following the
same admissions, testing, advising and enrollment procedures as all students new to the college. This includes providing current high school/home
schooled transcripts, meeting ACT/SAT or placement score requirements and course prerequisites.
Students in this category are not considered degree or certificate seeking until completion of high school/GED. These students must list
“undeclared” as a major until completion of high school/GED or past the age of compulsory attendance.

Phone Registration Tips: During   Main             East Springfield Eastern Region  Southern Region Western Region Western Region
peak registration the main line   Campus           Learning Center Education Center Education Center Education Center Education Center
on campus experiences heavy
usage. We recommend
contacting a regional center.
                                  Springfield    Springfield            Taylorville            Litchfield           Jacksonville    Beardstown
Regional center staff can
                                  217-786-2298 217-522-9205             217-287-7081 or        217-324-2090 or      217-243-6699 or 217-323-4103 or
register students for any class   1-800-727-4161 217-522-9047           1-800-572-5448         1-800-858-9193       1-888-494-1622 1-877-800-4406
offered at any location.                                                                                                             2/08 – 9/08 Edition