Legal Name _________________________

Social Security Number______–______–_________

Date of Birth ___/___/____

Gender ___ Male ___Female

Email ___________________________

Term and year of enrollment ___Fall ___Spring 20 _____

Permanent Address ____________________________

City____________ State__________ County ___________

Zip Code + 4 ___________

How long have you lived at the above address? ____________

Home Telephone _______________

Enrollment Type

Freshman Commuter Transfer Special

Returning High School GED

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

Term and Year of Expected Enrollment ___ Fall ___ Spring, Year _________

Anticipated Major ______________

Name of Parents or Guardian ______________

Parent Address _______________________

City ___________State _________ County __________

Zip Code _____________

Telephone ______________

Address _____________________

Name of School now Attending __________

Date of Graduation _______________

Address ___________________________

Name of High School Counselor __________________

List all high school, colleges, and universities attended:

School 1

Name ___________________________

Location ______________________

Dates Attended __________________

Diploma Received _____________________

School 2

Name ________________

Location __________________

Dates Attended __________________

Diploma Received __________________

School 3

Name _____________________________________

Location __________________________________

Dates Attended ___________________________

Diploma Received __________________________

School 4

Name ____________________________________

Location __________________________________

Dates Attended ____________________________

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: