Online College Admission Form

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College Admission Form

Applicant E-Mail
Important: Enter a valid e-mail address. Correspondance will be sent to this address.
E-Mail:*
Applicant Information
First Name:*
Middle Initial:
Last Name:*
Address Line 1:*
Address Line 2:		Apt. or Suite No.
City:*
State:*
Zip Code:*
Home Phone:*
Work Phone:*
Cell Phone:
Date of Birth*
Identification Number*
What is your marital status?*	Single Married Divorced Widowed
Ethnic Origin:
Educational Experience
Applicants must have all official high school, college transcripts and/or GED
Test scores sent directly to our College.
High School Experience:*
College Experience:*
Employment Status
Employment Status:*
Residency Status
Legal North Carolina Resident?*	Yes No
If yes, which county:
Date moved to NC:		(mm/dd/yyyy)
Driver`s License Number:*
State of Residence:*
Class Attendance
Day Classes:
Evening Classes:
Full Time:
Part Time:
Online Courses?*	Yes No
Enrollment:*
Educational Goals
Primary Goal:
High School Information
High School last attended:*
City/State:*
High School Graduate?*	Yes No
Graduation Date/Last Attended:*
Highest grade level:
Received GED:*	Yes No
GED School:
GED Date Received:		(mm/dd/yyyy)
By clicking the `Submit Application` button below, I hereby certify that all the
information I have given is accurate to the best of my knowledge.
Signature:*		Enter first & last name
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