The Center for Chinese Studies at Crichton College
* Required
Applicant Information
Enrollment Information
*Type of Applicant:
*Term of Entry Desired:
Fall Spring Summer
Month of Entry (AEP only)
August October January March June
*Year of Entry Desired:
Area of Interest :
Applicant Name
*Name:
First
Last
MI
Maiden
Home Address
*Home Address:
Country:
*City:
*State:
*Zip Code:
Contact Information
*E-Mail Address:
*Home Phone :
 
  
*Cell Phone:
Permanent Address (if different from Home Address)
Perm Address:
Country:
City:
State:
Zip Code:
Emergency Contact
*Name:
*Phone Number:
*Relationship:
Family History
(if married, please include information about one parent and your spouse)
Name of Father or Spouse
Full Name:
(Enter address below only if different from Applicant Address)
Home Address:
       
City:
State:
Zip Code:
E-Mail Address:
 
Home Phone:
     
Work Phone:
Name of Mother or Spouse
Full Name:
(Enter address below only if different from Applicant Address)
Home Address:
       
City:
State:
Zip Code:
E-Mail Address:
 
Home Phone:
     
Work Phone:
Education
High School Attended
High School:
Date of Graduation:
City:
State:
Other Institutions Attended
College/University
City/State
Dates Attended
Degree Earned
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to
to
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Personal Information
Personal Data
Date of Birth:
Gender:
Male Female
*Citizenship
U.S. Citizen
Non-Citizen
Resident Alien #
*International Students (if non-citizen)
Country of Birth
Country of Citizenship
 
For Federal Reporting Purposes
( The following information does not affect the admissions process. It is used for statistical purposes to provide information required by the U.S. Department of Education in accordance with applicable federal regulations. )
Ethnicity:  


Do you consider yourself to be of Hispanic/Latino/Spanish Origin?  
          Yes      No

Race:  

American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.)

Asian  (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)

Black or African American (A person having origins in any of the Black racial groups of Africa.)

Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)

White (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)

 
Marital Status:
Religious Preference

What is your
religious affiliation?
If OTHER, please specify:

How devoted are you to your religious affiliation?

Which house of worship do you attend most regularly?
Name of church, temple, fellowship, etc.
City, State
Name of Pastor/Bishop/Priest/Etc.
Veteran Information

Prior Military Service?

Yes      No

Branch of Service
Are you entitled to VA benefits?
Yes      No
  

Employment Information

Employer:

Job Title:
Crichton Specific
General
Have you already been working with an admissions counselor?
Yes    
Name
None/Don't know
Have you ever applied to
Crichton College?
Yes No
Have you ever attended
Crichton College?
Yes No
Alumni
Is someone in your family an alumnus/alumna of Crichton?
Yes No
If yes, who?
Name
Relationship:
Class of:
 
  
Financial Aid
• 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.
• Residence while at Crichton College:
 
On-Campus Housing With Family Off-Campus Apartment
Additional Comments:
Please supply any additional information we may need:
Read the following before submitting your application for admission:
I certify that to the best of my knowledge all statements submitted by me are correct, complete, and my own. I am aware that, if I enroll, all portions of this application will become part of my permanent file at Crichton College.  I understand that failure to provide accurate and complete information on the Educational Background section of this application can result in cancellation of the application, and/or revocation of admission and enrollment. I also understand my obligation to inform the College if information or circumstances indicated on this application should change. 

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.

 
 

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