Initial Application

Your application will be sent using a secure connection to prevent distribution of your information.

I Am Applying For: On Campus Spring 2010On Campus Fall 2010On Campus Spring 2011 On Campus Fall 2011 Online EducationLEAD Adult Degree Completion

First Name: Middle Name:

Last Name:

Address:

City: State: Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Country: Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt Eire El salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Israel Italy Jamaica Japan Jordan Kazakstan Kenya Kiribati Kuwait Kyrgystan Lao Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia (FYR) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates UK United States Minor Outlying Islands United States of America Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

Zip Code:

Email Address:

Phone Number:

Gender: Select one Male Female Date of Birth:

Marital Status: Select One Single Married Widower or Widow Separated Divorced

Spouse's Name:

Have either of your parents (or guardians) ever attended EC? No Yes
If yes, please provide their name(s):

Date of High School Graduation or GED: Month 01 02 03 04 05 06 07 08 09 10 11 12 Year

High School GPA: Current Class Rank: Unknown Top 10% 11-25% 26-50% 51-75% 75-100% Home Schooled
ACT Composite Score: PSAT Total Score: SAT Total Score:
Colleges attended, credit hours, and/or degrees earned:

In what areas of study are you most interested?

Of what local congregation are you a member?
Name:

City: State: Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

(if none, please explain)

Have you been convicted of any law violation other than minor traffic violations? No Yes
If yes, provide a full explanation:

In the space provided below, please provide any additional information that you feel would be helpful in our selection process

(e.g. why you want to come to EC, church service performed, community service performed, mission trips, club and organizational involvement, etc.):

How/where did you first learn about EC? Please choose one I received a letter I know a current student I know a former student My minister My youth minister A presentation at my church Church camp School counselor My parent(s) Google Internet search Yahoo Internet search MSN Internet search AOL Internet search Other Internet search Other

What is your preferred method of communication? No preference e-mail US mail Telephone

Do you recognize the Christian ideals of Ecclesia College, and are you willing to conduct yourself in harmony with these ideals? Yes No
(See our Student Life Handbook if this matter is in question.)

IT MAY TAKE A MOMENT TO PROCESS YOUR INFORMATION. PLEASE ONLY HIT SUBMIT ONCE! THANK YOU!