Please provide all of the following information.  Incomplete applications will not be accepted.  When complete, please click ONCE on the "Submit" button located at the bottom of the form.  To clear the form and start over, click once on the "Reset" button.  If you experience problems with this form, please contact the Bethany College Office of Admissions at 1-800-826-2281.


Student Name:
First Name:  Middle Initial:
Maiden Name:(if applicable)
Last Name: Nickname:
Gender: Male: Female:


Permanent Address:
Street Address:
Box # or Apt. #:
City:  * State: Select a State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code:  
E-mail Address:
Telephone:
Birthdate: Mo 01 02 03 04 05 06 07 08 09 10 11 12   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:  
Student Marital Status: Single    Married - Spouse's Name
                                  Divorced Separated

Name and address of person to whom official correspondence should be sent:
Name:
Address:
City:
State: Select a State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY       Zip Code:  

Education

Indicate the term you plan to enter:
Fall    Interterm    Spring     Summer      Year:
High School:
Year of Graduation:

Colleges attended since graduating from high school:

Have you been suspended or dismissed for academic or disciplinary reasons from any of the above schools?
Yes     No    If so, please explain:
                             

What have you been doing since you graduated from high school or were last enrolled in a college?
                              

How would you describe yourself?:
White, Anglo, Caucasian (non-Hispanic)
Asian or Pacific Islander
Black (non-Hispanic)
Hispanic or Latino/Latina
American Indian or Alaska Native
Multi-Ethnic
Other:

Religious Preference:

Do you have adequate funds to cover the fulll expense of your college work at Bethany College?
Yes       No

Do you intend to apply for financial aid?
Yes       No

I understand that if I become a degree-seeking student at Bethany College, I must go through the official application procedures in the Office of Admissions.

I hereby acknowledge that the information submitted is true and correct. I grant the college permission to forward any pertinent information to authorized offices and agencies. I agree to respect the traditions of Bethany Collee and abide by its rules and regulations.

Bethany College does not discriminate on the basis of sex, abilities, age, race, religion, sexual orientation, national or ethnic origin, or veteran status in the recruitment and admission of students, the recruitment and employment of faculty and staff, and the operation of any of its educational programs and activities, as specified by federal laws and regulations.

Please click once on the "Submit" button below to send your information electronically to the Bethany College Office of Admissions.  To clear the entire form, click once on the "Reset" button.