ࡱ> dfc%` Tbjbj"x"x 4^@@mt.M M M .".".".".".".$1h4jF.&+ "M &&F.[.***& .*& .**r6* {8'L*L,q.0.*m4L'Xm4*m4*M ="b*#$)M M M F.F.*M M M .&&&&  Semester/Year Fall ____ Spring____ Ϲ Limited Enrollment Registration Form  ADMISSIONS INFORMATION Name Last First Middle Social Security Number _______________________ Birth Date______________ Phone Number _ Mailing Address Number and Street City State Zip Code E-mail ___________________________________________ Occupation: Marital Status: ( Single ( Married (Spouse______________________) ( Widow(er) ( Divorced Church You Attend_________________________________ Ministers Name Address Number and Street City State Zip Code Phone ( ) ____________________ How frequently do you attend church? Emergency Contact Person___________________________ Relationship___________ Phone ( ) Any special health concerns? STUDENT STATUS: ( First Time Attendee ( Returning Last Semester Attended: (semester/year) ( Non-Degree (up to 12 hours) ( High School - Dual Enrolled ( Guest from Host School: DEGREE GOAL: (Associates (Bachelors (Undecided Major Area of Study/Interest: DEMOGRAPHIC DATA (optional): Ethnic Group: ( Native Hawaiian/Other Pacific Islander ( Black/African American ( American Indian/Alaska Native ( Hispanic/Latino ( Two or More Races ( White ( Asian Citizenship: Gender: ( United States ( Male ( Resident Alien ( Female ( Non-Resident AlienReligious AFFILIATION (optional):( Assembly of God ( Apostolic ( Baptist (Catholic (Christian Churches/ Churches of Christ ( Christian Reformed ( Church of Christ (non-instrumental)( Church of God ( Community Church (Disciples of Christ ( Evangelical Free ( Jewish ( Lutheran ( Mennonite (United Methodist ( Free Methodist(Islam ( Nazarene ( Non-Denominational ( Pentecostal ( Presbyterian ( Seventh-Day Adv. ( Wesleyan ( No Affiliation ( Other: ____________ COURSE NUMBERS COURSE NAMECREDIT HOURS DAYS TIMES ROOMSPECIAL * PERMISSION* Special Permission is for professors to initial approval for internships or classes for which prerequisites have not been met. Advisors Signature Total Credits Date Students Signature Date High school students who wish to enroll for up to 6 credit hours per semester may enroll using this registration form. After graduation, if you desire to continue taking classes, you must apply for full admission to the college. This process includes completing a regular application, paying the application fee, and having high school and other transcript(s) sent directly to Ϲ. Guest students who are participating in a cooperative program between Ϲ and another institution must complete this registration form to enroll in Ϲ classes. Other guest students may take up to 12 credits under this limited status. After 12 credits, you must complete the regular application process and be accepted as a Ϲ student. Have you been arrested for any criminal activity? ( Yes ( No If yes, give a full explanation of your activity and the case on a separate sheet of paper. Include the current status of your case. Ϲ does not have a policy of excluding individuals based on this information, but will consider each case to safeguard the security of the College. Ϲ admits students without discrimination as to race, gender, or physical disability. ENROLLMENT INFORMATION List the high school where you graduated and any college you have attended: High School Location Dates of Attendance Diploma College Location Dates of Attendance Diploma College Location Dates of Attendance Diploma COMMUNITY AGREEMENT Ϲ seeks to provide a community atmosphere where students can Love the Lord your God with all your heart and with all your soul and with all your mind. (Matthew 22: 37). As a part of this community, each person agrees to uphold an atmosphere of spiritual growth, evangelism, servanthood, respect for all individuals, moral and physical purity, honesty, integrity, and responsibility. If accepted as a student, I am willing to abide by this community agreement and all other guidelines set forth in the Catalog and Student Life Handbook. (Under the Family Education Rights and Privacy Acts of 1974, which gives students the right to examine their education records, students may waive their right to see specific confidential statements and letters of recommendation. In the belief that applicants and the persons from whom they request recommendations may wish to preserve confidentiality of the reference questionnaire, the College gives students the right to waive their right to examine questionnaires received.) I hereby grant permission to Ϲ to contact the minister of the church listed on this application. I agree that any such contacts shall not be regarded as an invasion of my privacy. I now affirm all the information on this application to be correct and true. 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