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Questionnaire

		Jamestown, ND 1-800-336-2554 Fax (701) 253-4318 For more information, including on-line applications go to: www.jc.edu and click on: Admissions
Your Success. Our Tradition.

Personal Information

Name:		Email:

Last Name		First Name		Prefer Name (Nickname)

Address:

Street Address		City		Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota North West Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washingtion Washington DC West Virginia Wisconsin Wyoming Yukon Territory State/Prov		Zip

Phone

Academics:

High School Name:		Graduation Year:

High School Cumulative GPA:		Composite ACT (if known):		Composite SAT (if known):

Academic Major Area		Career Interest Area

Please rank the 3 most important characteristics in choosing your ideal college.

Career Preparation Academic Field Location   Extra-Curricular Involement Liberal Arts Education Private Education   Graduate/Professional School Placement Other (Please fill in)

Please check all those activities you expect to participate in while in college.

Academic/Honor Societies Student Government Intramural Athletics   Community Service Spiritual Life Activities Campus Communications   Art Choir/Band Theatre   Intercollegiate (NAIA) Athletics (Indicate Sport)

Do you have a special interest or talent JC should know about?

What is your idea of the ideal distance from your home to attend college?

0-50 51-150 151-300 301 or more not important

Have you ever visited the Jamestown area?

Yes   No

Jamestown College campus?

Yes   No

Please check if you would like further information on any of these subjects.

Academic Field (Please fill in)    Graduate Success Internships Career Counseling & Placement Services   Resident Life Study Abroad Financial Aid Information   Information about the community

6000 College Lane	Admissions: 1-800-336-2554	Campus Map | Site Map
Jamestown, ND 58405	Email: admissions@jc.edu	Employment
1-701-252-3467	Request Information	Help Desk Request Form
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