Online Admissions Application

Date:

Term Applying For:

Choose one Fall, 2010 Spring, 2011 Summer, 2011

Application for:

What degree will you pursue?

Which degree interests you?

Choose one BA - Christian Ministry BA - Criminal Justice BS - Business/Accounting BS - Business/Finance BS - Business/Business Administration BS - Business /Information Systems BS - Business /International Business BS - Business /Marketing BS - Criminial Justice BS - Exercise Science BA - Early Childhood Ed BA - Elementary Ed BA - Health and Physical Education BS - Medical Imaging BSN - Nursing BA - Recreation Management BA - Sports Management BSBA - Online Degree Completion AA - Accounting AA - American Indian Studies AA - Art AA - Business Adminisratino AA - Child Development AA - Christian Ministry AA - Computer Science AA - Criminal Justice AA - Journalism AA - Life Science AA - Natural Resource Mgmt AA - Nursing AA - Radiography AA - Sonography Pre-Sonography Undecided

Type of enrollment:

Personal Information

Applicant's Legal Name:

Previous Names (if any) :

Street Address:

City:

County:

State/Province:

AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

Zip Code/Postal Code:

Country:

E-mail Address:

Place of Birth:
(city/town/village)

Home Phone:

Cell Phone:

Gender:

Male Female

Date of Birth:
(mm/dd/yyyy)

Country of Citizenship:

If you are a permanent U.S. resident, please give your Green Card Number:

If you are not a permanent resident, what visa status are you pursuing?

F-1 J-1

If your native language is not English, when did you take the TOEFL? (mm/dd/yyyy)

What was your TOEFL Score?:

Test format:

Paper Computerized

Religious Preference(Optional):

Academic Status:

Are you a U.S. veteran?

Yes No

Do you have any dependents?

Yes No

Marital Status:

Single Married

Employment Status:

Will you seek financial aid?(This question is only used for processing applications, and is not considered in the admission process.)

Yes No

Will you need campus housing?

Yes No

Ethnicity: Please check one or more (The following items are optional. This information is used only for purposes of statistical analysis and is not considered in the admission process.)

American Indian or Alaskan Native
Tribe:
Asian
Native Hawaiian or Other Pacific Islander
Black or African-American
Hispanic or Latino
Caucasian
Other (please specify)

Parent/Emergency Contact Information:

Name:

Address:

Telephone Number:

Alternate Phone Number:

Parents Marital Status:

Married Divorced/Separated

Do you live with a parent?

Yes No

High School Information:

Name of School:

Date of Graduation:

City and State:

Grade Point Average:

Class Rank:

of

Testing:

If not a high school graduate, date of your GED?

Select the records that have been submitted to Bacone College?

High School Transcript
GED Transcript
ACT Transcript
SAT I Transcript

What influenced you to apply to Bacone College?

Federal law allows students to prohibit the releasing of public or “directory” information. Please verify if you would like the college to release such information:

Yes No

Do both of your parents have a four year college degree?"

Yes No

List colleges you have attended:

College:

City, State:

Dates Attended:

College:

City, State:

Dates Attended:

College:

City, State:

Dates Attended:

If you have previously attended college, what is your degree status?

Please list all college transcripts you have submitted to Bacone College:

Have you ever applied to or attended Bacone College?

Yes If yes, when?
No

Yes If so, why?
No

Have you been contacted by anyone from Bacone College?

Yes
No If so, by whom

Programs of Interest

DECLARATION OF THE STUDENT

If accepted, I agree to abide by the rules and regulations of Bacone College. I certify that all information provide is correct. False statements may result in immediate dismissal from Bacone College. I authorize the use of photographs and other selected information for proper college purposes. As a dependent student, I hereby authorize Bacone College, its officers, agents and employees to communicate orally and in writing with my parent(s) or guardians. I fully understand that I am waiving my right to object to the release and provision of all such information by reason of it being personal, privileged information or on any other grounds.

NOTICE OF NONDISCRIMINATORY POLICY:

Bacone College admits students of either gender or any race, color, creed, religion, national and ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students at the college. It does not discriminate in administration of its educational policies, athletics, or other college programs. Please remember to mail your official transcripts after submitting this form.