Michelle’s Test

Tell us a little about yourself

* First Name:
Middle Initial:
* Last Name:
* SSN:
* Email:
* Confirm Email:
* Cell Phone:
Home Phone:
* Address:
* City:
* State:
* ZIP:
* Country:
* Gender:
* Birthdate: Month: Day: Year:
What is your religious affiliation?

U.S. Department of Education Demographic Information

The U.S. Department of Education has established new guidelines for collecting and reporting aggregated ethnic and racial data. In order to respond to this request, we ask you to answer the following questions.
Do you consider yourself to be Hispanic, Latino, or of Spanish origin?
 Yes No
In addition, please select one or more of the following racial categories to describe yourself.

When would you start classes at Bethany ?

* Desired Entry Date: Year:
 Fall Spring Summer
* Select Program of Interest:

Where did you attend previously?

* College Name:
Years Attended:
* High School:
* Graduation Year:

Financial Aid

* Do you intend to apply for financial aid?
 Yes No
* Have you been convicted of a felony?
 Yes No

Questions or comments?

Terms of Application

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.

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.

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 College and abide by its rules and regulations.

By submitting this application and if I am accepted into the program, I will be responsible for payment for all charges that are incurred.

I understand and accept these terms.
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