New Student Online Application Form

Student Online Application Form

Applicant Name

Title

First Name

Middle Name

Last Name

Street

City

State/Province

Zip/Postcode

Country

if not USA

General Information

Home Phone

Work Phone

Cell Phone

Social Security Number

If Other, please specify

(Passport number, etc.)

Maiden Name

Previous Name/s if applicable

Marital Status

Gender

Birth Date

Education Level

United States citizen

Yes No Not Selected

Program

How Did You Learn Of Our College?

When Do You Plan to Enroll

Location Status

If Other, please explain:

Have you ever been convicted of a Felony

Yes No Not Selected

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

Picture File

Educational History

High School Diploma or GED?

Date Graduated or GED issued

(mm/yyyy)

Name of HS

(IF APPLICABLE - where you received HS diploma)

HS City

HS State

Have you contacted your HS to have a transcript sent?

Yes No Not Selected

College Attended

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)

City

State

Graduate

Yes No Not Selected

Degree Awarded & Year

Major or Subject

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

School Name 2

City

State

Graduate

Yes No Not Selected

Degree Awarded & Year

Major or Subject

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

School Name 3

City

State

Graduate

Yes No Not Selected

Degree Awarded & Year

Major or Subject

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

School Name 4

City

State

Graduate

Yes No Not Selected

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

Veteran Information

Branch of Service

Date of Entry

Date of Discharge

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 Gl Bill (MGIB)

Chapter 31 - Vocational Rehabilitation and Employment

Chapter 33 - Post 9/11 GI Bill

Chapter 35 - Depending Educational Assistance Program

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

Other

If Other, please list

Signature

Date:

(mm/dd/yyyy)

Signature:

$50.00 Application Fee is Non-Refundable

Enter the above code

Required