Geneva College

Academics

 

Adult Degree Programs - Application

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*Geneva College does not discriminate on the basis of race,
color, sex, disability and national or ethnic origin.

I am applying for:
Please select a preferred major:
B.S. Organizational Leadership
B.S. Human Resources
B.S. Organizational Development
B.S. Human Services
B.S. In Christian Ministry Leadership

Choose your intended start date and location:

Online | Apr. 21, 2014 ( Online )
Pittsburgh | Aug. 26, 2014 ( )
Undecided(choose later)

Choose your intended start date and location:

Cranberry Twp. | Jun. 4, 2014 ( )
Undecided (choose later)

Choose your intended start date and location:

Online | Apr. 21, 2014 ( )
Online | Oct. 6, 2014 ( )
Undecided (choose later)

Choose your intended start date and location:

Online | Apr. 21, 2014 ( )
Cranberry Twp. | Jun. 4, 2014 ( )
Pittsburgh | Aug. 21, 2014 ( )
Monroeville | Aug. 27, 2014 ( )
Online | Oct. 6, 2014 ( )
Undecided (choose later)

Choose your intended start date and location:

Pittsburgh | Aug. 21, 2014 ( )
Beaver Falls | Aug. 26, 2014 ( )
Johnstown | Aug. 28, 2014 ( )
Everett | Oct. 7, 2014 ( )
Undecided (choose later)
Personal Information

First Name
Middle Name
Last Name
Other names used in previous college
Preferred Name
Permanent Address
City
Zip Code
County
State
Home Phone
Work Phone
Cell Phone
Email Address
Fax
Social Security Number
Gender Male Female
Birth Date
Citizenship
If other, please specify.
If other, are you a permanent resident of the US? Yes No
Visa type
Denomination (if any)
Job Title/Position
Employer/Organization
Will you be applying for financial aid?
Yes No
Are you eligible to receive any tuition benefit from your employer?
Yes No
Are you eligible to receive any military tuition assistance or veterans education benefits?
Yes No
Are you a member of Phi Theta Kappa International Honor Society?
Yes No
Have you ever been academically dismissed from, declared ineligible to attend or incurred disciplinary action at any institution?
Yes No
Have you ever been convicted of or plead guilty to a felony or misdemeanor (excluding traffic violations)?
Yes No
If yes, please list the date of the conviction(s), name/location of court in which convicted and a description of the nature of the crime.

Educational Information
High school diploma (date received)
GED (date received)
Do you have college credit?
Yes No
List all colleges, universities or other post-high school institutions of learning you have attended (include Geneva if you are a former student)
College attended and dates of attendance
Estimated Total Credits

Geneva College will request transcripts, at no cost to you, from all institutions* you have previously attended.
An enrollment counselor will connect with you to complete the Transcript Request form for each school you attended.

*Colleges and universities in the U.S.


Military Experience? Yes No
Branch:
Dates:
(please send a copy of your DD214 )

Ethnicity (optional)
Do you identify yourself as a person of Hispanic/Latino origin? Yes No
How are you most comfortable describing yourself? (Check all that apply)
American Indian or Alaska native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White

*Geneva College does not discriminate on the basis of race, color, sex, disability and national or ethnic origin.



Where did you first learn about the Geneva College Adult Degree Programs?


Please sign this form by typing your name and typing the date in the spaces provided below.
Your signature validates this application and indicates that you have completed the information and that the information is true.
Name:
Date:
Return E-mail address:

Questions? Email adcp@geneva.edu or call us at 800-576-3111


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