Term: Fall Spring Summer
Permanent Mailing Address:
Telephone:( ) - Fax #:( ) -
Address of Present Residence (To send I-20 and other correspondence):
Telephone:( ) -
Fax#:( ) -
Citizenship: US Other
If other specify:
If other, are you a permanent resident of the US? Yes No
Birthdate (month/day/year): January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /
Gender: Male Female
Do you have a Social Security Number? Yes No
If yes, please provide Social Security Number: - -
Pastor's Full Name:
Phone Number:( ) -
Please list all universities at which you have taken courses for credit (whether or not credit was received). Please note that concealment of previous work will cancel and nullify the processing of your application and is grounds for dismissal from Geneva.
Please list your native language:
Years of formal study of English language:
TOEFL Scores (give dates of each examination):
Honors and Activities List any scholastic distinctions or honors you have received in secondary school. Also include any activities/athletics you have participated in and any leadership positions you have held.
Anticipated activities at Geneva:
List other schools you are applying to:
Name of Parents/Guardians:
Parent's Address (if different from above):
Are you married? Yes No
Number of Children:
Name of Spouse (if married):
Maiden Name (if applicable):
Please list the dependents who will come to the US with you:
The following information will help us assist you while at Geneva. You will not be discriminated against in the admissions process because of this information.
1. Have you ever been diagnosed as having a learning disability? Yes No
2. Do you have any health conditions or physical disabilities that require special attention? Yes No
Please note:You will be billed for health and accident insurance when you arrive, unless you submit proof of insurance when you arrive. The cost to you will be approximately $804 per year.
How did you first learn of Geneva?
Short Answer Essay Questions:In 3-5 sentences, please thoughtfully answer the questions below.(Note: Your answers to these questions may be used in the scholarship selection process.)
1. Why are you interested in pursuing a Christian education at Geneva College?
2. What are your goals and how do you see Geneva College helping you achieve them?
3. What distinguishes you for consideration among your peers as a student at Geneva College?
I certify that the information in all of my credentials is complete and accurate to the best of my knowledge and I understand that the falsification of information may be grounds for immediate dismissal from my studies. I agree to comply with any necessary regulations while enrolled at Geneva College.
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.
Geneva offers an Adult Degree Completion Program (ADCP) to finish a degree in Human Resources, Human Services, Christian Ministry Leadership or Organizational Development.
3200 College Avenue Beaver Falls, PA 15010800-847-8255 • email@example.com
2013 Geneva College | All rights reserved