Ancilla College Online Application

Please fill out the entire application form. * Indicates required field

Last Name *
First Name *
Middle Name
Former Name (Indicate any former name(s) under which educational records are listed.)
Gender Male Female
Date of Birth * / MM / DD YYYY
Social Security Number (Submitting your Social Security Number (SSN) is not required, and your SSN will not be used to create a student identification number, but it is required to receive certain federal tax benefits. Your SSN is also sometimes helpful to accurately match some records like SAT or ACT test scores.)
Current Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
County (Indiana Residents only)
Home Phone * - (###) - ### ####
Cell Phone (if different) - (###) - ### ####
Email Address *
Marital Status (please choose one) Single Married Divorced Separated Widowed Prefer not to answer
What is your country of birth? *
Residency * U.S. Citizen Student Visa, Non-U.S. Citizen Permanent Resident (holder of Green Card) Non-U.S. Citizen
Non-U.S. Citizens Only - Country of Citizenship
Racial/Ethnic Background (Although optional, the ethnic information is requested to fulfill reporting obligations to the federal government) American Indian/Alaskan Native Asian Black (non-Hispanic) Hispanic Native Hawaiian/Other Pacific Islander White (non-Hispanic) Bi-racial Other
Are you the first person in your family to go to college? Yes No
Religious affiliation (optional) Catholic Non-Catholic Other
Parent/Guardian/Spouse (If under 21)
Parent/Guardian/Spouse Address (if under 21)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Parent/Guardian/Spouse Phone (if under 21) - (###) - ### ####
Where did you hear about Ancilla College?
Entry Term:
(When do you plan to start at Ancilla as a student?) Spring (starts Jan 14, 2013) Summer 1 (starts May 20, 2013) Summer 2 (starts July 1, 2013) Fall (starts Aug 19, 2013)
Degree Program
Associate's Degree concentration Behavioral Science Business Administration Communication Criminal Justice Early Childhood Education Education Elementary Education Environmental Technology Exercise Science General Studies Health Science History Logistics & Inventory Systems LPN to RN Bridge Program Nursing (ASN) Professional Health Sciences Secondary Education Science Undecided
College Transfer Programs Athletic Training Biochemistry Environmental Science Exercise Science/Kinesiology Fitness Studies Occupational Therapy Physical Education Physical Therapy Sports Marketing and Management
Intercollegiate Athletics Cheerleading (men & women) Men's Baseball Men's Basketball Men's Golf Men's Soccer Women's Basketball Women's Softball Women's Volleyball
Date of H.S. graduation or GED completion:
Education High School GED Home School
Name of high school (currently attending or last attended)
Address of high school (currently attending or last attended)
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
SAT
ACT
If you have been out of high school less than three years indicate the date you took or will take SAT/ACT
I would like to...
(check all that apply) Be a full-time student Complete my degree at Ancilla College Transfer credits from another school Take courses, but do not plan on a degree Be a part-time student, eventually earn a degree Take only 1 or 2 courses Take summer courses only
Entry Status I will be attending college for the first time. I will be transferring between 1 and 29 credit hours from another college. I will be transferring between 30 and 60 credit hours from another college. I will be transferring with a degree. I previously attended Ancilla College. I will be an Early Bird student (high school junior or senior).
College Transcripts
List the full name of all colleges, universities, technical schools, military training facilities, or other institutions you are currently or have attended (other than high school). List the most recent school first. If you have not attended any post-secondary institution, write "none." (Note: Federal financial aid rules require a complete list. Failure to indicate every institution attended may result in denial of admission.)
Institution
Address for Institution
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Date Attended From at Institution
Date Attended To at Institution
Date Transcript Requested from Institution / MM / DD YYYY
Institution 2
Address for Institution 2
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Date Attended From at Institution 2
Date Attended To at Institution 2
Date Transcript Requested from Institution 2 / MM / DD YYYY
All college transcripts are required
Please make sure to have every college and university you have preciously attended send official transcripts as soon as possible to:
Office of Admissions, Ancilla College, PO Box 1 Donaldson, IN 46513
How did you hear about Ancilla College? (Choose all that apply) Friend or relative attended Ancilla Mail High school guidance counselor Recruited by a coach High school visit Ancilla's website Other
Privacy:
May we release your telephone number and email address to student directories and college publications? Yes No
Accuracy statement (IMPORTANT)
I certify that the information provided on this application is accurate and true. I understand that falsified information may result in denial of admission and termination of enrollment at Ancilla College. I agree to abide by the policies, rules and regulations of Ancilla College. I authorize my high school, and any other educational institutions attended, to furnish all academic and personal information information requested by the Ancilla Admissions Office. I authorize Ancilla College to report my academic progress to my counselor and program adviser for the purposes of curriculum and instructional development. I authorize the Office of Financial Aid to release appropriate information on my academic progress, including grades, and the amount of any aid and award I receive to state, federal and other agencies, institutions, and others involved in providing funds for my education.
Date of Application * / MM / DD YYYY
Signature (enter your full name) *
Verification
Please enter any two digits with no spaces (Example: 12) *

Recent
Upcoming

Tuesday, May 14

Men's Golf

Ancilla at	No Team Score
NJCAA Region XII Championship - Day 2 - 18 Holes
results

Monday, May 13

Men's Golf

Ancilla at	No Team Score
NJCAA Region XII Championship - Day 1 - 36 Holes
results

No Events in the next 14 days.

MCCAA - Michigan Community College Athletic Association

NJCAA - National Junior College Athletic Association

Ancilla College Online Application

Ancilla College Online Application

All college transcripts are required Please make sure to have every college and university you have preciously attended send official transcripts as soon as possible to: Office of Admissions, Ancilla College, PO Box 1 Donaldson, IN 46513

All college transcripts are required
Please make sure to have every college and university you have preciously attended send official transcripts as soon as possible to:
Office of Admissions, Ancilla College, PO Box 1 Donaldson, IN 46513