Please fill out the below application only if we do not already have an application on file for you. If you have already applied, please contact the admissions office for assistance. Thank you.

Information that is red is required

Contact Information

First Name

Middle Name

Last Name

Suffix

Email Address

Social Security Number

Date of Birth -- month -- 01 January 02 February 03 March 04 April 05 May 06 June 07 July 08 August 09 September 10 October 11 November 12 December -- day -- 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- year -- 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903

Gender -- choose one -- Female Male

Are you of Hispanic origin? -- choose one -- NO YES

Ethnicity -- choose one --

If not, please idicate all that apply

White

Black or African American

Asian

American Indian or Alaska Native

Hawaiian or Other Pacific Islander

Citizenship Status -- choose one -- International Student Not U.S. Citizen Resident Alien U.S. Citizen

Citizenship Country -- choose one -- United States CANADA AFGHANISTAN ALBANIA 999 ALGERIA ANDORRA ANGOLA ANTIGUA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA BOTSWANA BRAZIL BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI CAMBODIA 555 CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CEYLON CHAD CHILE CHINA COLOMBIA COMOROS CONGO COSTA RICA COTE D"LVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR ENGLAND EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE FRENCH ANTILLES FRENCH GUIANA GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUADELOUPE GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE HONDURAS HONG KONG HONG KONG HUNGARY I'V''O"RY C"OA'ST ICELAND II INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA KUWAIT KYRGSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW ZEALAND NICARAGUA NIGER NIGERIA NORTH KOREA NORTHERN IRELAND NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL PRINCIPE QATAR REPUBLIC OF CHINA ROMANIA RUSSIA RWANDA SAN MARINO SAO TOME SAUDI ARABIA SCOTLAND SENEGAL SERBIA SEYCHELLES SIERRA LEON SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SOUTH-WEST AFRICA SPAIN SRI LANKA ST. KITTS ST. LUCIA ST. NEVIS ST. VINCENT SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKSTAN TANZANIA Test Test2 THAILAND THE GRENADINES TOBAGO TOGO TONGA TRINIDAD TUNISIA TURKEY TURKMENISTAN TUVALU UAE UGANDA UKRAINE UNITED KINGDOM UPPER VOLTA URUGUAY UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM WALES WEST AFRICA West Indies WESTERN SAMOA YEMEN ZAIRE ZAMBIA ZIMBABWE

Marital Status -- choose one -- Divorced/Seperated Married Single Widowed

Home Address

Country -- choose one -- UNITED STATES CANADA AFGHANISTAN ALGERIA ANDORRA ANGOLA ANTIGUA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA BOTSWANA BRAZIL BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI CAMBODIA 555 CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CEYLON CHAD CHILE CHINA COLOMBIA COMOROS CONGO COSTA RICA COTE D"LVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR ENGLAND EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE FRENCH ANTILLES FRENCH GUIANA GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUADELOUPE GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE HONDURAS HONG KONG HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA KUWAIT KYRGSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW ZEALAND NICARAGUA NIGER NIGERIA NORTH KOREA NORTHERN IRELAND NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL PRINCIPE QATAR REPUBLIC OF CHINA ROMANIA RUSSIA RWANDA SAN MARINO SAO TOME SAUDI ARABIA SCOTLAND SENEGAL SERBIA SEYCHELLES SIERRA LEON SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SOUTH-WEST AFRICA SPAIN SRI LANKA ST. KITTS ST. LUCIA ST. NEVIS ST. VINCENT SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKSTAN TANZANIA THAILAND THE GRENADINES TOBAGO TOGO TONGA TRINIDAD TUNISIA TURKEY TURKMENISTAN TUVALU UAE UGANDA UKRAINE UNITED KINGDOM UPPER VOLTA URUGUAY USA, ISRAEL UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM WALES WEST AFRICA West Indies WESTERN SAMOA YEMEN ZAIRE ZAMBIA ZIMBABWE

Address Line 1

Address Line 2

Address Line 3

City

State or Province -- choose one -- ALABAMA ALASKA AMERICAN EMBASSY AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA GUAM 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 PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINA WISCONSIN WYOMING

Zip Code

Telephone  Ext:

Cell Phone  Ext:

Province

Postal Code

International Phone Number  Ext:

International Cell Phone  Ext:

Mailing Address

Country -- choose one -- UNITED STATES CANADA AFGHANISTAN ALGERIA ANDORRA ANGOLA ANTIGUA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA BOTSWANA BRAZIL BRUNEI BULGARIA BURKINA FASO BURMA BURUNDI CAMBODIA 555 CAMEROON CAPE VERDE CENTRAL AFRICAN REPUBLIC CEYLON CHAD CHILE CHINA COLOMBIA COMOROS CONGO COSTA RICA COTE D"LVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR ENGLAND EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FIJI FINLAND FRANCE FRENCH ANTILLES FRENCH GUIANA GABON GAMBIA GEORGIA GERMANY GHANA GREECE GRENADA GUADELOUPE GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HOLY SEE HONDURAS HONG KONG HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY IVORY COAST JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA KUWAIT KYRGSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW ZEALAND NICARAGUA NIGER NIGERIA NORTH KOREA NORTHERN IRELAND NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL PRINCIPE QATAR REPUBLIC OF CHINA ROMANIA RUSSIA RWANDA SAN MARINO SAO TOME SAUDI ARABIA SCOTLAND SENEGAL SERBIA SEYCHELLES SIERRA LEON SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH KOREA SOUTH-WEST AFRICA SPAIN SRI LANKA ST. KITTS ST. LUCIA ST. NEVIS ST. VINCENT SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAIWAN TAJIKSTAN TANZANIA THAILAND THE GRENADINES TOBAGO TOGO TONGA TRINIDAD TUNISIA TURKEY TURKMENISTAN TUVALU UAE UGANDA UKRAINE UNITED KINGDOM UPPER VOLTA URUGUAY USA, ISRAEL UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM WALES WEST AFRICA West Indies WESTERN SAMOA YEMEN ZAIRE ZAMBIA ZIMBABWE

Address Line 1

Address Line 2

City

Mail State -- choose one -- ALABAMA ALASKA AMERICAN EMBASSY AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA GUAM 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 PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINA WISCONSIN WYOMING

Mail Zip Code

Phone Number  Ext:

Mail Province

Mail Postal Code

Mail International Phone  Ext:

Academic Information

School Level -- choose one -- G.E.D. High School Student Other status Transfer

Prior School Grad Year -- choose one -- 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915

College Level -- choose one -- Senior Junior Sophomore Freshman

Prior School GPA Out Of

Last School Attended School Lookup

Last College Attended College Lookup

Select Preferred Major:

Intended Major -- choose one -- Business Administration: AS Business Administration: BS Early Childhood Education: AA Liberal Arts: AA Natural Sciences: AS Religous Studies: AA Religious Studies: BA Undecided

Anticipated Starting Semester -- choose one -- Summer I 2013 Summer II 2013 Fall 2013 Spring 2014

Resident Code -- choose one -- Commuter Resident

Do you have a physical or learning disability? -- choose one -- No Yes

Veteran -- choose one -- Not a Veteran Yes, I am a Veteran

Additional Information

How did you hear about us?

Do you have any previous criminal convictions? -- select one --No, I do not have any previous criminal convictions Yes, I have a previous criminal conviction

If you indicated yes, please indicate if it was a felony or a misdemeanor -- select one --I answered no above Misdemeanor Felony

Are you a first generation college student? -- select one --No, I'm not first generation college student. Yes, I'm a first generation college student.

Are you a resident of South Carolina? -- select one --No, I'm not a South Carolina Resident Yes, I'm a South Carolina Resident

Please indicate your state of birth

Are you a resident of the Tri-Coumty Area -- select one --Chester County Lancaster County York County I am not from the Tri-County Area

Which of the following tests have you already taken?

PSAT	SAT
ACT	TOEFL
ASSET/COMPASS	I have not taken any of these tests

If you have an interest in Math/Science criteria goes here

Are you interested in a career in Science and/or Technology? -- select one --No, I'm not interested Yes, I'm intersted in a career in Science and/or Technology

Are you interested in playing basketball at Clinton Junior College?

Men's Basketball

Woman's Basketball

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