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Application for Admission to FCC

Please fill out this application in its entirety.
You will have the option of paying the application fee online via credit card / PayPal , or printing the application and mailing a check.

Enrollment Information:

Desired Program: Traditional Day Program Alternative Degree Completion Program

Desired Enrollment Status:
For a description of these categories, please see the Student Classifications Matrix in the FCC Academic Catalog.

Degree Seeking Student Non-degree Seeking Student Audit Student
Dual Enrollment Early Enrollment

If accepted I plan to enroll:
Traditional Program:
Working adult education program (LEAD): month/year

Student Status: First Time Student Transfer Student Re-admission

Last date of attendance:
Reason for leaving Florida Christian College:

Desired Residence: Campus Apartment (Please see Application Checklist for more info) Off Campus

Personal Information

Full Name:
Preferred Name:
Social Security #:
Birthdate:	year Age:
Other name(s) under which your transcript could be found:

Gender:	Male Female
Mailing address for admissions correspondence:
Street or box Number:
City:	State: Zip:
Email:
Home Phone:
Work Phone:
Mobile Phone:

Country of Citizenship (Please Check One)

U.S. Citizen
Permanent Resident Alien
Non-resident of U.S.

Country of Citizenship:
If already in the U.S., do you currently hold a visa?
Yes Expiration date:
No

Marital Status

Single Engaged Married Divorced Widowed

Please give the following information concerning fiance(e):
Fiance(e) Name: Age: Wedding Date:
Former F.C.C. Student Enrolled Enrolling

Please give the following information concerning spouse:
If you are relocating, will spouse be moving with you? Yes No
Spouse Name: Age: Wedding Date:
Former F.C.C. Student Enrolled Enrolling

List Your Dependants:
(list full names, ages, and relationship to you)

Church Background

Are you a Christian?	Yes No If Yes, how long?
How often do you attend church?	Weekly or more Two to three times a month Less than two to three times a month
Name of church currently attending:

How long have you attended this congregation?

Address of current church
Minister(s):
Have you been baptized into Jesus Christ through water immersion?
	Yes No

Character Background

If your answer to either of the following questions is yes, please submit a full statement (50 - 75 words) in the area below the question. This statement is to explain your involvement in these activities and how you believe these choices have impacted your Christian walk. In addition you may be required to furnish all official documentation explaining the final disposition of the proceedings.

Have you ever been charged with or subject to disciplinary action for scholastic misconduct or any other type of misconduct at any educational institution?
Yes No

Have you ever been charged with a violation of the law which resulted in, or, if still pending, could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver's license (including traffic violations which resulted in a fine of $200.00 or more)? If your records have been expunged pursuant to applicable law, you are not required to answer yes to this question.
Yes No

Please carefully review FCC's Lifestyle Standards (beginning on page 24) as stated in the Student Life Handbook

Do you agree to abide by the FCC Lifestyle Standards as stated in the Student Life Handbook while you are a student at Florida Christian College ?
Yes No

If your answer to the following question is no, please submit a full statement (50 - 75 words) in the area below the question. This statement is to explain your involvement in these activities and how you believe these choices have impacted your Christian walk.

Have the lifestyle choices that you have made in the past 12 months been consistent with FCC Lifestyle Standards as stated in the Student Life Handbook?
Yes No

Educational Information:

High School you now attend (or from which you graduated)
High School Name:
Address:
Date of entry:
Date of graduation:
Is your school	Public Private Parochial Home schooled

Was your secondary education completed in a home school that state law treats as a home or private school?
Yes No

Did your state issue you a secondary school completion credential?
Yes No

List all other secondary schools you have attended beginning with ninth grade.
(include name of school, city, state, zip, and dates attended)

GED/High School Equivalency:
(include name of institution, city, state, zip, and date completed)

College Information:
List all colleges/universities at which you have taken courses. Please have an official transcript sent from each institution as soon as possible.
(include name of college/university, city, state, zip, dates attended, and degree earned)

Military Information:

Have you ever served in the Military? Yes No

Branch:
Dates of service:
Please obtain a DD214 form or the equivalent and forward it to Florida Christian College.

Test Information:

Official test results must be mailed to Florida Christian College by the testing agency unless they accompany an official high school transcript.

ACT Date taken/to be taken:
English Score:
Math Score:
Reading Score:
Science Score:
Composite Score:

SAT Date taken/to be taken:
Verbal Score:
Math Score:

Test of English as a second language (TOFEL or other exam) (International Students only)

Test:
Test Date taken/to be taken:
Score:

Miscellaneous Information

How did you hear about FCC?
(Check all that apply)

Minister Youth Minister FCC Alumnus FCC web site
Phone Book Friend Parent Billboard Radio New Life/CIY Team

College Guide which one?
College Event which one?
Other, please describe

Required Authorization

My name typed into the field below indicates that all the information in my application is complete, factually correct, and truthfully presented. Furthermore, I certify that I know the moral and educational standards of Florida Christian College and I pledge to abide by the college standards and policies.

I understand that this application does not guarantee acceptance.

date 7/27/2008 3:45:53 AM