Online Application - DCP

Please check your major:	Community Ministry
	Human Resources
	Human Services
	Organizational Development
Start Date:
Location:
Personal Data
Mr. Mrs. Ms.
First Name:
Middle Name:
Last Name:
Maiden Name:
Other names used in previous college:
Preferred Name:
Permanent Address:
City:
Zip Code:
County:
State:
Home Phone:
Work Phone:
Fax:
Social Security Number:
Gender:	Male Female
Marital Status:	Single
	Married
Birth Date:
Citizenship	US Other
If other, please specify.
If other, are you a permanent resident of the US?	Yes  No
Job Title/Position:
Employer/Organization:

Are you eligible to receive any tuition reimbursement from your employer?	Yes  No
Are you a member of Phi Theta Kappa International Honor Society?	Yes   No
Previous Education
List all colleges/universities previously attended (include Geneva if you attended in the past.)
Geneva College admits students of any race, color, gender, religion, handicap and national or ethnic origin.
Name of College
Estimated Total Credits
Military Experience: (please include a copy of your DD214 )
Branch:
Dates:
Occupational Specialty:
Ethnicity (optional):	American Indian
	Caucasian
	Hispanic/Latin American
	Asian or Pacific Islander
	African American (Non-Hispanic)
	Biracial

Application Essay

In a 400- to 500-word essay, tell us why you are applying to this program, what areas of your life do you hope to strengthen through your participation in the DCP, and what life experiences have helped to prepare you to pursue your educational goals. If you are applying for the community ministry major, include a brief statement of your personal Christian faith.

Where did you hear about our Web site? Where did you first hear about the Degree Completion Program?

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: