APPLICATION FOR ADMISSION
[email protected] • admissions.graceland.edu 1 University Place • Lamoni, Iowa 50140 866-472-2352 (866-GRACELAND) • 641-784-5196
APPLICATION FOR ADMISSION Personal Data
Items you feel may be discriminatory are optional.
Name ___________________________________________________________________________________________________
Last (Family Name)
First
Middle
Preferred First
Maiden Name
Permanent Address _________________________________________________________________________________________
Street/PO Box
City and State/Province
ZIP/Postal Code
_________________________________________________________________________________________
Country (if not U.S.)
Country of Birth
Phone ( ________ ) __________________________________ _Cell Phone (________ ) ___________________________________
Area Code
Area Code
Date of Birth _______________________________________
MM
/
DD
/
Gender
YYYY
Citizenship (if not U.S.) _____________________________________________ Resident Alien
qM qF q Yes q No
Social Security Number (U.S.) ________________________________________ Canadian SIN ____________________________ Email: ___________________________________________________________ Religious Preference: _______________________ Social Networking Preference: ________________________________________________________________________________ Do you consider yourself to be Hispanic/Latino? q Yes q No In addition, select one or more of the following racial categories to describe yourself: q American Indian or Alaska Native q Asian q Black or African American q Native Hawaiian or Pacific Islander q White Have you ever been convicted of, or plead guilty or no contest to a felony, misdemeanor (excluding parking or speeding violations), or forfeited bail for any criminal conduct under law or ordinance? (If yes, attach details.) q Yes q No Enrollment Information This application is for the 20
– 20
academic year.
Please check all boxes that apply to you. Beginning Term q Fall q Winter q Spring q Summer Enrollment q Full-time (12+ semester hours) q Part-time (fewer than 12 semester hours)
Classification q Transfer q New Freshman q Previously Attended q Postgraduate q Graceland Graduate:____/____
*Desired Major: (1st Choice) ________________________________ (2nd Choice) _____________________________________ *International students must declare a major to obtain a Visa.
Financial Aid Will you be applying for financial aid? q Yes q No Please indicate whether you are a dependent of any of the following: q Graceland University employee q SkillPath Seminars employee q Community of Christ appointee or World Church employee
Educational Data List in chronological order ALL high schools and colleges you have attended (use additional sheet if necessary). q I have a GED. I did not graduate from a high school.
q I was homeschooled.
Name of City State/ High School(s)/ College(s) Province _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________
GPA ________ ________ ________ ________
Date graduated and degree, if any _________________________ _________________________ _________________________ _________________________
ACT/SAT Score ____________ ____________ ____________ ____________
Please list the colleges you are considering, including Graceland. ________________________________________________________________________________________________________ How did you learn about Graceland University? ___________________________________________________________________ List school activities which you would like to participate in at Graceland. (Honors, Enactus, Visual and Performing Arts, Athletics, etc.)_ ________________________________________________________________________________________________________ List school honors and awards. ________________________________________________________________________________
Family Data required if under 21 Do either of your natural or adoptive parents have a four-year degree? q Yes q No With whom are you living? q Father q Mother q Guardian q Spouse q Self q Other ____________________ Name(s) _________________________________________________________________________________________________
First
Last
Address _______________________________________________________ __________________________________________
Street/PO Box
Email Address
__________________________________________________________________________________________________ City
State/Province
ZIP/Postal Code
List full names, birth dates, and year in school of school-age siblings or children (use additional sheet if necessary). ______________________________________________________ ________________________ ________________________
First
Last
Birth Date
Year in School
______________________________________________________ ________________________ ________________________
First
Last
Birth Date
Year in School
______________________________________________________ ________________________ ________________________
First
Last
Birth Date
Year in School
Has anyone in your family attended Graceland University (formerly Graceland College)? q Yes q No Name Relationship to You Approximate Dates of Attendance ________________________________________________________________________________________________________ ________________________________________________________________________________________________________
Contract All full-time students (enrolled in 12 credit hours or more) are required to live in university housing. Exceptions to this policy are listed in the University catalog. Upon acceptance, Graceland may publish information about me in my hometown newspaper. I agree to support the rules and regulations of the University as specified in official publications. I realize that this application becomes a part of my permanent record at Graceland. Having completed this application to the best of my ability, I hereby request admission to Graceland University. APPLICANT’S SIGNATURE _______________________________________ DATE _________________________________
Non-Discrimination Policy: Graceland University does not discriminate against any student or prospective student on the basis of race, color, religion, age, sex, national origin, disability, or sexual orientation. We are a caring community dedicated to the physical, intellectual and spiritual well-being of each individual. Gracelanders join together to create an atmosphere of openness, mutual respect and diversity.
4/13 11118
APPLICATION FOR ADMISSION Personal Data
Items you feel may be discriminatory are optional.
Name ___________________________________________________________________________________________________
Last (Family Name)
First
Middle
Preferred First
Maiden Name
Permanent Address _________________________________________________________________________________________
Street/PO Box
City and State/Province
ZIP/Postal Code
_________________________________________________________________________________________
Country (if not U.S.)
Country of Birth
Phone ( ________ ) __________________________________ _Cell Phone (________ ) ___________________________________
Area Code
Area Code
Date of Birth _______________________________________
MM
/
DD
/
Gender
YYYY
Citizenship (if not U.S.) _____________________________________________ Resident Alien
qM qF q Yes q No
Social Security Number (U.S.) ________________________________________ Canadian SIN ____________________________ Email: ___________________________________________________________ Religious Preference: _______________________ Social Networking Preference: ________________________________________________________________________________ Do you consider yourself to be Hispanic/Latino? q Yes q No In addition, select one or more of the following racial categories to describe yourself: q American Indian or Alaska Native q Asian q Black or African American q Native Hawaiian or Pacific Islander q White Have you ever been convicted of, or plead guilty or no contest to a felony, misdemeanor (excluding parking or speeding violations), or forfeited bail for any criminal conduct under law or ordinance? (If yes, attach details.) q Yes q No Enrollment Information This application is for the 20
– 20
academic year.
Please check all boxes that apply to you. Beginning Term q Fall q Winter q Spring q Summer Enrollment q Full-time (12+ semester hours) q Part-time (fewer than 12 semester hours)
Classification q Transfer q New Freshman q Previously Attended q Postgraduate q Graceland Graduate:____/____
*Desired Major: (1st Choice) ________________________________ (2nd Choice) _____________________________________ *International students must declare a major to obtain a Visa.
Financial Aid Will you be applying for financial aid? q Yes q No Please indicate whether you are a dependent of any of the following: q Graceland University employee q SkillPath Seminars employee q Community of Christ appointee or World Church employee
Educational Data List in chronological order ALL high schools and colleges you have attended (use additional sheet if necessary). q I have a GED. I did not graduate from a high school.
q I was homeschooled.
Name of City State/ High School(s)/ College(s) Province _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________
GPA ________ ________ ________ ________
Date graduated and degree, if any _________________________ _________________________ _________________________ _________________________
ACT/SAT Score ____________ ____________ ____________ ____________
Please list the colleges you are considering, including Graceland. ________________________________________________________________________________________________________ How did you learn about Graceland University? ___________________________________________________________________ List school activities which you would like to participate in at Graceland. (Honors, Enactus, Visual and Performing Arts, Athletics, etc.)_ ________________________________________________________________________________________________________ List school honors and awards. ________________________________________________________________________________
Family Data required if under 21 Do either of your natural or adoptive parents have a four-year degree? q Yes q No With whom are you living? q Father q Mother q Guardian q Spouse q Self q Other ____________________ Name(s) _________________________________________________________________________________________________
First
Last
Address _______________________________________________________ __________________________________________
Street/PO Box
Email Address
__________________________________________________________________________________________________ City
State/Province
ZIP/Postal Code
List full names, birth dates, and year in school of school-age siblings or children (use additional sheet if necessary). ______________________________________________________ ________________________ ________________________
First
Last
Birth Date
Year in School
______________________________________________________ ________________________ ________________________
First
Last
Birth Date
Year in School
______________________________________________________ ________________________ ________________________
First
Last
Birth Date
Year in School
Has anyone in your family attended Graceland University (formerly Graceland College)? q Yes q No Name Relationship to You Approximate Dates of Attendance ________________________________________________________________________________________________________ ________________________________________________________________________________________________________
Contract All full-time students (enrolled in 12 credit hours or more) are required to live in university housing. Exceptions to this policy are listed in the University catalog. Upon acceptance, Graceland may publish information about me in my hometown newspaper. I agree to support the rules and regulations of the University as specified in official publications. I realize that this application becomes a part of my permanent record at Graceland. Having completed this application to the best of my ability, I hereby request admission to Graceland University. APPLICANT’S SIGNATURE _______________________________________ DATE _________________________________
Non-Discrimination Policy: Graceland University does not discriminate against any student or prospective student on the basis of race, color, religion, age, sex, national origin, disability, or sexual orientation. We are a caring community dedicated to the physical, intellectual and spiritual well-being of each individual. Gracelanders join together to create an atmosphere of openness, mutual respect and diversity.
4/13 11118
