Admission Application

Legal Name
Social Security Number ––
Date of Birth
Gender Male Female
Email (Required)
Permanent Address
City State County
Zip Code + 4
How long have you lived at the above address?
Home Telephone
 
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
 
Enrollment Type
Freshman Commuter Transfer Special
Returning High School GED
 
Term of Expected Enrollment Fall Spring
Year of Expected Enrollment
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 Schools, 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 No
If Yes, Please List Dates Attended
If Yes, Name(s) Under Which Records May Be Filed
 
Do You Wish to Live in a Dormitory Yes No
If No, Please State Reason
 
Have You Submitted the Free Application for Federal Student Aid (FASFA)
Yes No
If Yes, 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: