Jamestown College Application Print

	Application for Admission

Please include with this application:	$20 Application fee
	Copy of your high school transcripts (and college transcripts, if applicable)

I am applying for admission as a:
First-Year Student	Transfer Student	Part-Time/Non-Degree/Other Student

I am applying for term beginning (complete year):
Fall (August 20_____)	Spring (January 20_____)	Summer (May 20_____)

Personal Information________________________________________________________

Full Legal Name:

Male Female

Email: ________________________________________

_______________________ Last Name	_______________________ First Name	_______________________ Middle Name

_______________________ Maiden Name	_______________________ Prefer Name (Nickname)

Permanent Home Address:

__________________________________
Street Address

___________________
City

_______
State/Prov

________-_____
Postal Code

(____) ____-______
(Area Code) Telephone

Mailing Address (if different from home address, please give your mailing address for all admissions correspondence):

__________________________________
Street Address

___________________
City

_______
State/Prov

________-_____
Postal Code

(____) ____-______
(Area Code) Telephone

If mailing and home addresses differ, after what date should correspondence be sent to your home address?

____/____/______ (mm/dd/yyyy)

Date of Birth: ____/____/_____ (mm/dd/yyyy)

SSN: _____-____-_______

Country of Birth: _____________________

Country of Citizenship: ___________________

Single Married

(if married, please provide the following information about your spouse):

____________________
Last Name

____________________
First Name

____________________
Middle Name

__________________________
Occupation

Parents' Information:

__________________________ Father's Last Name	__________________________ First Name	____________________________________ Occupation	Step-Father

__________________________ Mother's Last Name	__________________________ First Name	____________________________________ Occupation	Step-Mother

Check if appropriate:

Father Deceased

Mother Deceased

Parents Divorced

Parents Separated

Give the full name, relationship, and address of the parent or guardian with whom you legally reside and to whom official college correspondence should be sent:

________________________________
Name

__________________
Relationship

________________________________
Address

(____) ____-______
(Area Code) Telephone

If any members of your family have attended Jamestown College, please give their names, relationship, and class year:

________________________________________ Name	______________________ Relationship	_________ Class Year

________________________________________ Name	______________________ Relationship	_________ Class Year

Have you ever been convicted of, plead guilty or no contest to, or entered into a plea agreement with respect to a crime resulting in imprisonment, probation, or court or administrative supervision? Yes No

If yes, please provide the date of arrest, case number, name, and
address of the court, sentence imposed, and current status:

__________________________________________________________________________________________________________

Have you ever been subject to any penalties, either scholastic or disciplinary, at any college or university? Yes No

If yes, when, where, why:

__________________________________________________________________________________________________________

Previous Education________________________________________________________

High Schools and Colleges Attended

(most recent school first):

________________________________________ Name	_____________________________ Location	___________ to ___________ Period of Attendance (mm/yyyy)

________________________________________________________________________ Date of Graduation/Reason for Leaving

________________________________________ Name	_____________________________ Location	___________ to ___________ Period of Attendance (mm/yyyy)

________________________________________________________________________ Date of Graduation/Reason for Leaving

Optional (self-reported/estimated):

High School Cumulative GPA: ___________		College GPA: ___________

Composite ACT (if known): ___________		Composite SAT (if known): ___________

Optional Information________________________________________________________

What course of study/major(s) do you plan to follow at Jamestown College?

__________________________________________________________________________

What extra-curricular activities do you plan to continue or develop at Jamestown College?

__________________________________________________________________________


_______________________________________ Applicant Signature		__________________________ Today's Date

Mail to:

Office of Admissions, Jamestown College

6081 College Lane

Jamestown, ND 58405

(701) 252-3467 ext. 5562 (800) 336-2554

Statement of Nondiscrimination

Jamestown College confirms its support of the principles and practices of nondiscrimination and equality of races and sexes in its employment and in all of its programs, activities, and opportunities available to students. Jamestown College also affirms a commitment to nondiscrimination and reasonable accommodation of those students who are disabled. It is the expressed intent of Jamestown College to be in conformity with all laws relating to higher education which are consistent with our commitment to the Christian ethic, including Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Students who believe they may have a qualifying disability should request a complete copy of policies and procedures available from the Office of Admissions, the Learning and Academic Advising Center, the Vice President for Student Affairs or the Vice President for Business Affairs.