Application for
Online Studies

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
-- Certificate of Medical Coding
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.**

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