Legal Name

Social Security Number
––
Date of Birth (MM/DD/YY)

Gender MaleFemale

Permanent Address

City                                State     County
   
Zip Code

Email

Home Telephone
(xxx)xxx-xxxx

How long have you lived at the above address?


Term and year of enrollment:
Fall Spring 20

Enrollment Type:
Freshman Commuter Transfer Special
Returning High School GED

Anticipated Major

Ethnic Origin (Not required and will not be used for admission purposes; for statistical purposes only)
African American Hispanic
American Indian or Alaskan Native Caucasian (White) Asian/Pacific Islander Other

Resident Alien Yes No
U.S. Citizen Yes No

 
Name of Parent(s) or Guardian

Address

City                                State      County
   
Zip Code

Email

Telephone
(xxx)xxx-xxxx

Name of School now Attending


Date of Graduation
(MM/DD/YY)

 School Address

Name of High School Counselor

List all high school, colleges, and universities attended:
 

School 1

School 2

Name

 Name

Location

Location

Dates Attended
(MM/DD/YY)

Dates Attended
(MM/DD/YY)

Diploma Received

Diploma Received

School 3

School 4

Name

 Name

Location

Location

Dates Attended
(MM/DD/YY)

Dates Attended
(MM/DD/YY)

Diploma Received

Diploma Received

Have you previously attended Alice Lloyd College?

Yes, Date from to
No
If yes, name(s) under which records may be filed:
 

Do you wish to live in a dormitory Yes No
If "No" state reason:

Have you submitted the Free Application for Federal Student Aid (FASFA)
Yes No
Month/Year Submitted:

When did you or do you plan to take a college entrance exam?
ACT (Month/Year)  
SAT (Month/Year)

List any community and school organizations in which you have participated and held leadership positions.

What has most influenced your decision to apply to Alice Lloyd College?

IMPORTANT: Please answer all the question below:

1. Are you presently charged with or have you ever been convicted of a   felony or misdemeanor other than traffic violation?
Yes No

2. Have you ever been placed on disciplinary probation, academic suspension, or dismissed by any school or college?
Yes No

If the answer to any of the above question is yes, please explain: