New Student Online Application Form

Student Online Application Form

Applicant Name

The applicant must be at least 18 years of age at the time of program start

Driver's License / State ID Image

Please upload a photo that is NOT more than 300KB if possible.

Social Security Number

If Other, please specify

(Passport number, etc.)

Previous Name/s if applicable

When Do You Plan Enroll

United States citizen

Yes No Not Selected

How Did You Learn Of Our College?

If Other, please explain:

Have you been convicted of a Felony?

Yes No Not Selected

High School Diploma or GED?

Date Graduated or GED issued

(mm/yyyy)

Name of HS

(IF APPLICABLE - where you received HS diploma)

Have you contacted your HS to have a transcript sent?

Yes No Not Selected

Have you previously attended any other program for Funeral Service Education

Yes No Not Selected

If yes, what college

**********************************************

Total Years of College Completed

School Name 1

(Include Address and Telephone Number)

Graduate

Yes No Not Selected

Degree Awarded & Year

Major or Subject

**********************************************

Degree Awarded & Year

Major or Subject

**********************************************

Degree Awarded & Year

Major or Subject

**********************************************

Degree Awarded & Year

Major or Subject

**********************************************

Please list any other colleges or schools attended

Official College Transcripts must be sent to the college. Have you contacted all previous colleges to have these sent?

Yes No Not Selected

Disability Information

Will you need any resources, support, and /or accommodations while attending our college?

Yes No Not Selected

If YES, please explain the resources, support and /or accommodations necessary

If you are a veteran, do you expect to receive veterans benefits while attending college?

Yes No Not Selected

Please Check One

Chapter 30 – Montgomery GI Bill (MGIB)

Chapter 31 – Vocational Rehabilitation and Employment

Chapter 33 – Post 9/11 GI Bill

Chapter 35 – Dependents Educational Assistance Program

Chapter 1606 – Montgomery GI Bill –Selected Reserve (MGIB-SR) Assistance Program

Other

If Other, please list

Next-of-Kin Contact Information

Emergency Contact Information

Experience in Funeral Service

Do you work or have you ever worked for a Funeral Home

Yes No Not Selected

How long have you worked in the industry?

I intend to practice in the state of

I am aware of the requirements of the indicated state.

Yes No Not Selected

I am a resident of the state of

Do you have a relative active in Funeral Service?

Yes No Not Selected

If "Other", how is this person related to you?

Date:

(mm/dd/yyyy)

A $50.00 non-refundable application fee is required

Enter the above code

Required

Student Online Application Form

Applicant Name

General Information

Educational History

College Attended

Disability Information

Veteran Information

Next-of-Kin Contact Information

Emergency Contact Information

Experience in Funeral Service

Signature

A $50.00 non-refundable application fee is required