| Application Procedures |
New Freshmen:
Be sure to complete tasks listed on the preceding page; your application cannot be processed until Standardized Test Scores and high school transcripts are received. |
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All required fields will be represented with a red asterisk(*).
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| Personal Information |
| *First Name |
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| *Middle Name |
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| *Last Name |
Suffix
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| Preferred Name |
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| *Birth Date (mm/dd/yyyy) |
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| Prefix |
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| *Gender |
Male
Female |
| Social Security Number |
(numbers only please) |
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| Permanent Mailing Address: |
| *Address 1 |
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| Address 2 |
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| *City/Town |
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| *State/Province |
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| *Country |
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| *Zip Code |
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*Primary Telephone Number
(area code + number) |
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Secondary Telephone Number
(area code + number) |
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| E-Mail Address |
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| Citizenship Information |
| Are you a U.S. citizen? |
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Yes
No |
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| If NO, please select your country of citizenship |
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| If NO, are you a permanent resident alien, refugee or political asylum? |
Yes
No |
| If YES, list Permanent Resident Card Number
(AKA Green Card) |
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| If NO to both entries above, please complete the following: |
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| Select type of U.S. Visa |
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| Visa issue date (mm/dd/yyyy) |
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| Visa expire date (mm/dd/yyyy) |
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| Family / Guardian Information |
FATHER:
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Deceased?
Yes
No
Do you live with this person?
Yes
No |
| Prefix |
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| First name |
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| Middle name |
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| Last Name |
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Suffix
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| Father's current mailing address: |
| Address 1 |
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| Address 2 |
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| City/Town |
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| State/Province |
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| Country |
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| Zip Code |
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Home phone
(area code + number) |
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| Fathers's current employment: |
| Employer name |
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Work phone
(area code + number) |
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MOTHER:
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Deceased?
Yes
No
Do you live with this person?
Yes
No |
| Prefix |
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| First name |
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| Middle name |
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| Last Name |
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Suffix
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| Mother's current mailing address: |
| Address 1 |
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| Address 2 |
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| City/Town |
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| State/Province |
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| Country |
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| Zip Code |
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Home phone
(area code + number) |
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| Mother's current employment: |
| Employer name |
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Work phone
(area code + number) |
-
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GUARDIAN:
(if applicable) |
Deceased?
Yes
No
Do you live with this person?
Yes
No |
| Prefix |
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| First name |
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| Middle name |
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| Last Name |
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Suffix
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| Guardian's current mailing address: |
| Address 1 |
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| Address 2 |
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| City/Town |
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| State/Province |
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| Country |
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| Zip Code |
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Home phone
(area code + number) |
-
-
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| Guardian's current employment: |
| Employer name |
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Work phone
(area code + number) |
-
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| Family Members |
List names and relationships of family members who have attended CCU
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List names of younger brothers and sisters and anticipated years of high school graduation
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