Fill this application out in its entirety and press the submit button.  The Electronic signature at the bottom must be completed for the application to be processed.

Your application will be processed upon receipt.  You will receive an email response from the Office of Admissions.  If you do not receive an email response within 72 hours, you should resubmit the online application or use the printable application (see link below).  AOL users should use the printable application due to AOL's anti-spam programs that do not allow automatically generated emails.  You will need to mail a photocopy of your ACT original scores to the address below (not necessary if ACT scores appear on your official high school or college transcript).

PRCC
Office of Admissions
Box 5559
Poplarville, MS  39470
(ph. 601-403-1214)

Click here for printable credit card authorization form
(Use your browser's back button to return to this page)

Click here for a printable application (You must have Adobe Acrobat Reader to print this application.  Click here to download the Adobe Reader.

 

Today's date:
Month:  Day:  Year: 20  

Social Security Number  - -

Last Name: First Name:
Middle Name: Maiden or other name used:

Address:
City:    State:      Zip:
 
County (if Mississippi resident)
.
Phone: Day 
(Area Code)
- -
Phone: Night
(Area Code)
- -

Your Date of Birth:

Month:  Day:  Year: 19

Your Age
 
Your Sex:

Male
Female

Your Marital Status:

Single
Married

 

Your Race:  *Confidential information requested on a voluntary basis.  Refusal to provide this information will not subject the applicant to any adverse treatment, and the information will be used in a manner consistent with applicable Civil Rights Laws.

Caucasian
African American
Hispanic
Native American
Asian/Pacific Islander
Other
Specify (if "Other")



Who should we notify in case of emergency?

Name: (Last)      (First)     (Middle)
Address:      City:      State:      Zip:
Phone: (Area Code) - -

Relationship to applicant:

Parent
Spouse
Guardian
Other
(specify if "Other")



In what field do you plan to major?

Type Degree or Certificate you are working toward:

A. A. (Academic)
A. A. S.  (Technical)
Certificate (Career)
Non Degree

Which location do you plan to attend?

Poplarville Campus
Forrest County Center at Hattiesburg
Hancock Center at Waveland
Other
Which location (if "Other")

When do you plan to enter PRCC?

Summer 20
Fall 20
Spring 20
Summer 20


Your High School or GED Information:
 
High School Attended:
High School Address, City, & State:

Did you graduate?

Yes
No
 
Date of Graduation
GED? Please specify state.
Have you previously attended PRCC?

Yes
No

Dates attended PRCC
Name used when attending PRCC


If you have attended another college or university, please list below:
 
Name of Institution:
Dates of attendance:
Address of Institution:
Credits earned:
Degree earned:
Name of Institution:
Dates of attendance:
Address of Institution:
Credits earned:
Degree earned:
Name of Institution:
Dates of attendance:
Address of Institution:
Credits earned:
Degree earned:


Have you taken the A.C.T.?

Yes
No

When (MM/YY)

Did you have your scores sent to PRCC?

Yes
No



Pearl River Community College requires applicants to answer the questions: “Have you ever been convicted of a felony?” and “Have you ever been expelled and/or dismissed from another college or university for disciplinary reasons?”  An applicant who answers “yes” will be required to submit additional information and schedule a meeting with the Dean of Student Services.  The College reserves the ultimate decision on acceptance or rejection of any application.  Applicants should also be aware that an individual with a felony conviction may not be able to obtain licensure in certain professions.  In such cases where a felony conviction will prevent the student from applying for state licensure in a specific area, the student will be denied admission to that specific program.

Have you ever been convicted of a felony?

Yes
No..

Have you ever been dismissed from another college or university for disciplinary reasons?

Yes
No..

If you answer “yes” to either question, contact the Dean of Student Services to schedule an appointment for an interview.  (601-403-1215)

An official transcript of all previous work must be received in the Admissions Office before a student is officially accepted.  Return to: 

ADMISSIONS OFFICE
BOX 5559
POPLARVILLE, MS 39470

The Poplarville Admissions phone number is (601) 403-1214.   

If applying to our Forrest County Center, please send application, transcripts, and ACT scores to: 

PEARL RIVER COMMUNITY COLLEGE
FORREST COUNTY CENTER
5448 U.S. HWY 49 SOUTH
HATTIESBURG MS, 39401

The Forrest County Center Admissions phone number is (601) 554-5555. 

Pearl River Community College offers equal educational and employment opportunities to all persons without regard to sex, race, religion, color, national origin, handicap, or age.



Verification:  Type in your initials and your date of birth.  By typing in your initials and your date of birith, you are verifying that the information you are sending is true and you wish to be admitted to Pearl River Community College.  
I AGREE THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND THAT DELIBERATE FALSIFICATION OF INFORMATION MAY RESULT IN DENIAL OF ADMISSION TO P.R.C.C.
Type your initials here 
 Type your date of birth here  (MM/DD/YYYY)

Press the "Send to PRCC" button to transfer this information to Pearl River Community College, Office of Admissions.  If for some reason you do not receive and email acknowledging our receipt of your application within 72 hours, you should resubmit your application, use the printable version of the application, or call 601-403-1197 and request that an application be sent to you by U. S. mail.


 

 


.
© 2008 by Pearl River Community College
Office of Public Relations
All rights reserved.
PRCC
101 Highway 11 North
Poplarville, Mississippi 39470
601-403-1000
E-mail