Michelle’s Test Tell us a little about yourself * First Name: Nickname: Middle Initial: * Last Name: * SSN: * Email: * Confirm Email: * Cell Phone: Home Phone: * Address: * City: * State: ---InternationalALAKASAZARCACOCTDEDCFLGAGUHIIDILINIAKSKYLAMEMDMHMAMIFMMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVAVIWAWVWIWY * ZIP: * Country: ---United StatesAfghanistanAkrotiriAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAshmore and Cartier IslandsAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBassas da IndiaBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCoral Sea IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDhekeliaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropa IslandFalkland Islands (Islas Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambia, TheGaza StripGeorgiaGermanyGhanaGibraltarGlorioso IslandsGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJan MayenJapanJerseyJordanJuan de Nova IslandKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontserratMoroccoMozambiqueNamibiaNauruNavassa IslandNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParacel IslandsParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSpratly IslandsSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTromelin IslandTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin IslandsWake IslandWallis and FutunaWest BankWestern SaharaYemenZambiaZimbabwe * Gender: Male Female * Birthdate: Month: ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day: ---01020304050607080910111213141516171819202122232425262728293031 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.---American Indian / Alaska NativeAsianBlack / African AmericanNative Hawaiian / Pacific IslanderWhiteHispanic, Latino, or Spanish Origin OnlyI Choose Not To Answer When would you start classes at Bethany ? * Desired Entry Date: Year: Fall Spring Summer * Select Program of Interest: BA Criminal JusticeBA ManagementBA Interdisciplinary Studies 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. Please enter the characters below.