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Adult Education Application for Admission education degree

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Adult Education Application for Admission education degree Powered By Docstoc
					                          Accelerated Degree Program, Adult Education
                            APPLICATION FOR ADMISSION
                 Thank you for applying to Concordia College–New York
Please submit this completed Application Form with TWO checks payable to Concordia College: one
for $25.00, application fee; the second for $100.00, tuition deposit. This deposit will be applied
toward the first term’s tuition and is non-refundable. {Credit and or debit cards are also accepted.}
Personal Information:
Mr./Mrs./Ms. _______________________________________________________                                    _______________________
                   Last                            First                       MI                              Social Security Number

MAIDEN OR FORMER LAST NAME {if applicable} ____________________________________________

Home Address _______________________________________________________________________________
                   Street/Apt #                            City                          State                 ZIP

Mailing Address (if different) ___________________________________________________________________
                                         Street/Apt #                   City                           State             ZIP

Cellular tel#________________________ Home tel#_____________________ Work tel#___________________
Are you a veteran?        Yes            No                       Email____________________________________________
Date of Birth _____/_____/_______ Place of Birth___________________ Citizenship______________________
Church Affiliation _______________________________ Denomination_________________________________
                              Optional                                                      Optional

I am applying to Concordia College Program of Study:
  Liberal Studies, A.A.     Undeclared Bachelor’s Degree <select this if you have less than 60 credits, then select your area of interest:
  Business Administration, B.S.         Health Care Administration, B.S.
  Behavioral Science, B.A.             Health Studies, B.S.
TERM:      SPRING _________ OR         FALL _________             CC-NY Re-admit {former Concordia College students}
Educational Background:
Check one:        High School Diploma___________________                       General Education Development (GED) Diploma
Please list ALL colleges and/or universities previously attended and request that an official transcript be
submitted from each.
College/University                     City            State               Credits Earned           Cum GPA

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
    I have requested that my official transcripts be forwarded to:
 Concordia College–New York, Office of Admission, Attn: Nereida Quiles, 171 White Plains Road, Bronxville, NY 10708
                    Accelerated Degree Program, Adult Education
Employment Experience: (Five years work experience is required for BA/BS degrees.)
List below your last two employers. Your complete work resume is also required for admission.
Employer #1
Employer ______________________________________ Dates Employed ______________________________
Address ______________________________________________ Phone________________________________
Title_______________________________________________________________________________________
Employer #2
Employer ______________________________________ Dates Employed ______________________________
Address ______________________________________________ Phone________________________________
Title_______________________________________________________________________________________

Association with Concordia:
How did you first learn about Concordia’s Accelerated Adult Education Degree Program?
                   Concordia Website                             Newspaper (name)_________________
                   Internet Search                               Alumnus/CC Grad ________________
                   Metro-North                                   Current CC Student _______________
                   Bus                Radio ______               Friend/Relative ___________________
                   Other [Please specify]____________________    Postcard



With this signature, I certify the information above is complete and true.

Signature _________________________________________________ Date _____________________________




Please direct questions, and submit your completed Application Form,                            Resume,
   Transcripts, Application Fee and Tuition Deposit to:
                                      Concordia College–New York
                               Office of Admission, Attn: Nereida Quiles
                                         171 White Plains Road
                                          Bronxville, NY 10708

                           Phone: 914.337.9300, x2147, Fax: 914.395.4636
                              Email: Nereida.Quiles@Concordia-NY.edu

				
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