Crowley's Ridge College - Providing on campus and online classes.

First Name Middle Name Last Name

Preferred Name

Address City State

County Zip Code

COMMUNICATIONS

Telephone	Mobile Phone
E-mail	Facebook

DEMOGRAPHICS

Social Security Number	Drivers License
Date of Birth	Gender	Marital Status	Children
Ethnicity		Citizenship

DEPENDENCY

Grades and Statements should be sent to:

ABOUT MY EDUCATION

LAST COLLEGE

Name of last college attended (if applicable)			Last year attended college
Did you leave in good standing?	If "NO" please explain

LAST HIGH SCHOOL

Name of last high school attended		GPA	Graduate/Graduated from high school in:
Address	City	State	Zip
GED m	ACT	If you have not taken the ACT, when do you plan to

ABOUT MY PLANS AT CRC

Desired Admission

Classification sought

Major field of study

ABOUT MY FAITH

Religious Group	Local Congregation	Member	Name of Minister
Address	City	State	Zip

ABOUT MY FAMILY

Father's name Is your father a CRC Alumnus?			Years at CRC
Address	City	State	Zip
Telephone	E-mail
Mother's name Is your mother a CRC Alumnus			Years at CRC
Address	City	State	Zip
Telephone	E-mail
List brother and sisters in school and their grade levels

Where did you learn about our Electronic Classrooms? (Google or a friend etc)

LEGAL ISSUES

Have you ever been arrested by any law enforcement agency

If, YES, please explain

WAIVER OF RIGHT TO ACCESS TO CONFIDENTIAL INFORMATION

NOTE: PLEASE READ BEFORE PROCEEDING

Realizing the need for Crowley’s Ridge College to obtain an objective opinion as to my qualifications, I hereby waive my right to access any confidential recommendations made for the purpose of determining my fitness for admission to this institution. I also authorize the release of any relevant information in regard to this application for admission. I further certify that I have disclosed all relevant information in regard to this application for admission.

AGREEMENT

Please type
"I agree" or "I do not agree"
waive my right of access in the box above

I certify that the preceding statements and information are correct and complete. If accepted for enrollment, I pledge to abide by the policies of Crowley's Ridge College.

Full Name

Date