Piedmont Virginia Community College

Application For Admission

Prefix Mister

First Name Stanley

Middle Name T

Last Name Florez

Suffix Sr.

SSN (not specified)

Former First Name

Former Middle Name

Former Last Name

Date of Birth 7/6/2000

College Piedmont Virginia Community

College

Campus Main Campus

Class Type CRED

Term 2018 Fall between 08/20/2018

and 12/17/2018

Plan Electronics and Computer Tech

(981)

Previous Student or Employee N

Emplid 7326132

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Primary Phone 757-893-6404

Street Address 1 1071 Tenmile

Street Address 2

City Norfolk

Postal Code 23502

Country Iraq

Current Residence VIRGIN ISLANDS

Have you lived in Virginia the past twelve Y

months?

Email Rock4software@gmail.com

Student's Employer (If Employed)

Business Phone --

Emergency Contact First Name Lion

Emergency Contact Last Name Rock

Emergency Contact Relationship Other

Emergency Contact Phone 757-419-4586

Ethnicity

Gender Male

English is Primary Language Y

Military Status No Military Service

Citizenship Status Native

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Level of high school education High School (graduated or
currently enrolled)

School Attended Washington & Lee High School

Actual or Anticipated Graduation Date Feb 2018

Diploma Type Standard

College Univ Virginia

Attended From Apr 2015

Attended To Jun 2017

Degree Type Bachelor's

Were you suspended or dismissed from the last N

college attended?

Father's Highest Education Attended College

Mother's Highest Education Attended College

Are you a U.S. citizen? Yes

What is your military status? Have never served in the U.S.

military

Whose domicile do you want to use to claim My own domicile

eligibility?

Do you have legal dependents other than a Yes

spouse?

Are you a ward of the court or were you a ward of Yes

the court until age 18?

Are you married? No

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Are both of your parents deceased and do you No
have no adoptive parent or legal guardian?

Are you financially self sufficient? Yes

Do you have a bachelor's degree and are you Yes

working on a graduate degree?

Have you lived in Virginia for the last twelve Yes

months?

For last year you: filed as a resident in Virginia

and as a non-resident in
another state

For the last twelve months, have you held a No

Virginia driver's license or Virginia DMV ID?

For the last twelve months, have you held a No

driver's license or DMV ID in any other state?

For the last twelve months, have you owned or No

operated a motor vehicle registered in Virginia?

For the last twelve months, have you owned or No

operated a motor vehicle registered in any other
state?

For the last twelve months, have you been Yes

registered to vote in Virginia?

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 Application Confirmation

Name Stanley T Florez

Date Submitted 03/01/2018

Emplid 7326132

Username stf2036

Tuition Information Based on the residency

information you supplied, you
will receive in-state tuition rates.

Assigned Plan Electronics and Computer Tech

(981)

Administrative Contact Admissions Office

Phone 434-961-6551

Admissions Website http://www.pvcc.edu/next

Notice Before you can enroll in any

classes, you must provide
a parent or legal guardian's
signature to the college
Admissions Office

Notice You have been blocked

from enrollment for filing
taxes in two states. If you
think this is an error please
contact our Admissions and
Records Office. Please call
434-961-6551. You will be
unable to enroll for classes until
this is resolved.

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The signature of a parent or guardian is required for applicants under the age of
18.

Parent/guardian signature: ________________________________________

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