Crichton College - APS Online Application

APS Online Application

Welcome to the online application for the Adult and Professional Studies Program at Crichton College. Please completely fill out this application and click the SUBMIT button at the bottom of the page to get your college application moving. An admission counselor will contact your upon receipt of you online form. Please note that information on your applications fee payment will be provided once your online applications is submitted. We are excited that you are applying at Crichton and we look forward to serving you as you grow academically and spiritually.

Enrollment Information
I plan to start program in:
	Month:
	Year:

Intended Major:

*Prospective Student Information*
*Student Name*
	First Name:
	Last Name:
	Middle Name:
	Maiden Name:
	Date of Birth:
	If your name will appear in any other form on transcripts and documents, enter that name here:

Contact Information

	Street Address:
	City:
	State:
	Zip Code:

	Home Phone #:
	Work Phone #:
	Cell Phone #:
	Email Address:
	What is the best way to reach you?

Please list your current or most recent Employer.
	Employer:
	Address:
	City/State/Zip:
	Job Title:

*High School Information*
*High School Attended*
	High School Graduate or GED?	Yes No
	Graduation Year:
	School or GED:
	Location (City and State):

College/University Information

Other Institutions Attended

List all post secondary institutions attended and degrees earned (ie, colleges, universities, trade schools, etc.)
Institution	Location	Dates Attended	Degree Earned
		to
		to
		to
		to
		to

For Federal Reporting Purposes

The following information is optional and does not affect the admission process. It is used for statistical purposes and to provide information required by the U.S. Department of Education in accordance with applicable federal regulations. An answer in each category would be appreciated.

	Country of Birth:
	Country of Citizenship:
	Country of Residence:
	Resident Alien #:

Gender:	Ethnic Background:	Marital Status:
Male
Female


*Crichton Specific*
Have you ever applied to Crichton College?	Yes No	Have you ever attended Crichton College?	Yes No
How did you hear about Crichton?
	Type:	Name:
	Radio
	Church
	Alumni
	Billboard
	Other

Have you ever been charged or convicted of a felony?
		Yes No
If yes, when?
If Yes, please provide documentation regarding charge & conviction.
I plan to use the following resources to cover my educational costs (Check all that apply)
	Self-Payment		Financial Aid

	Employer Reimbursement		Employer Direct Payment
	percentage or amount paid by employer:

	Veteran's Benefits	Branch of Service:

	Other	Please Specify:

Financial Aid (Select all that apply)

Have you completed a FAFSA? Yes No

A FAFSA (Free Application for Federal Student Aid) is available from your high school counselor
or by calling our Financial Aid Office at 1.901.320.9787. You can also apply on-line at www.fafsa.ed.gov.
The school code for Crichton College is 009982.
International students are not eligible for federal funds and should not complete a FAFSA.

Additional Comments:

Please supply any additional information we may need:

Read the following before submitting your application for admission:

Once you submit this application, an admission counselor will be contacting you to let you know of any other necessary items to complete the admission process. Print a copy of this form for your records before pressing "submit".

If you need special accommodations or would like information concerning services for students with disabilities,
contact Crichton at (901)320-9777.

NOTICE OF NON-DISCRIMINATION POLICY FOR STUDENTS

Crichton College admits students of any race, color, sex, national and ethnic origin to all the programs and activities of the College with the rights and privileges generally accorded to students. It does not discriminate on the basis of race, color, sex, national and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and other university administered programs. It is the policy of Crichton College not to discriminate on the basis of sex in its educational programs, activities, or employment policies as required by Title IX of the 1972 Educational Amendments.