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:*  
Social Security 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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