Crichton College - Traditional Undergraduate Admissions

APPLICATION FOR ADMISSION

* Required

Applicant Information

Enrollment Information
*Are you interested in the:
*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
		to
		to
		to
		to
		to

*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

Optional Information for Identification Purposes Only
Ethnic Background: (Hold down Shift key to select all that apply)
Marital Status:

*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.