APPLICATION FOR ADMISSION - Trinity Christian College
APPLICATION FOR ADMISSION - Trinity Christian College
APPLICATION FOR ADMISSION - Trinity Christian College
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<strong>APPLICATION</strong> <strong>FOR</strong> <strong>ADMISSION</strong><br />
To apply for admission to the Adult Studies English as a Second Language/Bilingual Program,<br />
complete this form (please print) and submit a copy of your Illinois teaching license,<br />
sealed official college transcripts, and nonrefundable $25 application fee.<br />
Please return to: Adult Studies, <strong>Trinity</strong> <strong>Christian</strong> <strong>College</strong>, 6601 West <strong>College</strong> Drive, Palos Heights, IL 60463.<br />
ENDORSEMENT (CHECK ONE OR BOTH): qBILINGUAL<br />
qENGLISH AS A SECOND LANGUAGE<br />
DELIVERY <strong>FOR</strong>MAT (CHECK ONE): qON-CAMPUS qONLINE<br />
LEVEL (CHECK ONE):<br />
qUNDERGRADUATE qGRADUATE<br />
PERSONAL IN<strong>FOR</strong>MATION<br />
<br />
<br />
<br />
LAST name FIRST name M.I. MAIDEN name Birth date<br />
PERMANENT street address City State Zip<br />
Home Phone (include area code) Work Phone Cell phone<br />
<br />
E-mail address <br />
PRESENT address IF DIFFERENT from permanent<br />
Social Security<br />
Have you ever been convicted of a felony qYes qNo Gender: qMale qFemale<br />
CITIZENSHIP (check one): qUS Citizen qPermanent Resident qOther; citizen of<br />
RACE Hispanic/Latino qYes qNo<br />
In addition, check all ethnicity categories that apply:<br />
qAmerican Indian or Alaska Native qAsian qBlack or African American<br />
qNative Hawaiian or Other Pacific Islander qWhite<br />
MARITAL STATUS qSingle qMarried qDivorced/Widow<br />
RELIGIOUS AFFILIATION (check one; if Protestant list denomination)<br />
qCatholic qEastern Orthodox qProtestant<br />
qJewish qMuslim qNone Other<br />
PARENTS’ EDUCATION<br />
Highest degree obtained by father: qNo degree qBachelor’s qMaster’s qDoctorate qUnknown<br />
Highest degree obtained by mother: qNo degree qBachelor’s qMaster’s qDoctorate qUnknown<br />
<strong>Trinity</strong> <strong>Christian</strong> <strong>College</strong> maintains a policy of nondiscrimination on the basis of race, color, national origin, sex, handicap, or age, in its<br />
admissions policies, practices, and employment policies, as required by Title VI of the Civil Rights Act of 1964, Title IX of the Education<br />
Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975.
EMERGENCY IN<strong>FOR</strong>MATION<br />
Name of person to contact in an emergency<br />
Home Phone (include area code) Work Phone Cell phone<br />
Alternate person to contact in an emergency<br />
Home Phone (include area code) Work Phone Cell phone<br />
ILLINOIS LICENSE IN<strong>FOR</strong>MATION — If you need more space, please attach additional sheets to this application form<br />
<br />
<br />
<br />
<br />
<br />
Full name of college where teaching license was earned (or date expected)<br />
1<br />
2<br />
3<br />
Year awarded (or date expected)<br />
<strong>College</strong> street address City State Zip<br />
Type of Illinois license <br />
qElementary qSecondary qK-12 Illinois license number (if available)<br />
Full name of any other college attended <br />
Dates of attendance<br />
City State Zip<br />
Full name of college attended<br />
Dates of attendance<br />
City State Zip<br />
PERSONAL STATEMENT<br />
Please briefly state why you think this program will help you reach your personal and professional goals.<br />
I acknowledge that all of the statements in this application are accurate and complete to the best of my knowledge.<br />
APPLICANT’S SIGNATURE<br />
DATE
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