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Personal Information:
*
Denotes required fields
First:
*
Middle:
*
Last:
*
Social Security #:
*
Gender (M/F):
*
Street Address:
*
City:
*
State:
*
Zip:
*
Phone Number:
*
Other Phone Number:
Email:
*
Birth Date:
*
Religious Preference:
*
Church you attend:
Ethnic Group
(pick one)
:
American Indian or Alaskan Native
African American/Black
Caucasian/White
Asian or Pacific Islander
Hispanic
Citizenship - Are you a citizen of the United States? (Y/N):
*
Enrollment Information:
Term of enrollment:
Fall
Spring
Summer
Year
*
Status - Are you seeking a degree? (Y/N):
*
If Yes, what is your program of interest:
-- Bachelor of Arts in General Studies
-- Bachelor of Arts in Business Administration
-- Medical Information Technology (Associates Degree)
Plan to enroll (Full-time / Part-time):
*
Do you plan to file for financial aid? (Y/N):
*
Education Information:
Name of high school:
City/State:
Date of graduation
(mm/yy)
:
GED (Y/N):
Have you completed an Associates Degree? (Y/N):
Have you ever attended York College previously? (Y/N):
College(s) attended:
LIST MOST RECENT FIRST
College-1:
City/State:
From
(mm/yy)
:
To
(mm/yy)
:
GPA:
Number of Credits (completed):
In progress:
College-2:
City/State:
From
(mm/yy)
:
To
(mm/yy)
:
GPA:
Number of Credits (completed):
In progress:
College-3:
City/State:
From
(mm/yy)
:
To
(mm/yy)
:
GPA:
Number of Credits (completed):
In progress:
College-4:
City/State:
From
(mm/yy)
:
To
(mm/yy)
:
GPA:
Number of Credits (completed):
In progress:
Has a secondary school, college, or university dismissed you for any reason? (Y/N)
*
Have you been convicted of any crimes other than minor traffic violations? (Y/N):
*
If you answered "yes" to either of the last two questions, please send in a brief explanation.
Additional Comments:
How did you hear about York College?
If there is any additional information you would like our Admissions Office to consider, please use the space provided.
IMPORTANT - PLEASE READ AND INITIAL:
The information furnished in this application is true and complete. I will commit myself to upholding the ideals of York College and will personally maintain the highest moral, spiritual, and academic standards.
Initials of applicant:
*
Date:
*
**York College in Nebraska admits students without regard to race, color, gender, religion, disability, national or ethnic origin.**
