Probable Major
Educational Information
High School Attended
City, State
Years Attended
Date Graduated
Do you have a GED?
Do you expect to transfer credits from another college?
Which College?
City and State of College
Years Attended
Did you graduate?
Are you eligible to return to the last college or university you attended?
Have you taken the ACT?
Are you being home-schooled?
Family Information
Father’s Name (please indicate if deceased)
Father’s Occupation
Father’s Permanent Street Address
City, State, Zip
Home Phone
Work Phone
Mother’s Name (please indicate if deceased)
Mother’s Occupation
Mother’s address same as above?
Mother’s Permanent Street Address
City, State, Zip
Home Phone
Work Phone
Personal Information
Church Name (current membership)
Church Street
Church City, State, Zip
Church Phone
Name of Pastor
Pastor’s Home Phone
Will you be applying for a scholarship at GSBC?
Which scholarship?
Do you have any significant impairment?
Have you ever been treated for any nervous, mental, or emotional disorder, or been seen by a psychologist?
Have you ever used or sold illegal or dangerous drugs?
When was the last time?
Have you ever used alcoholic beverages?
When was the last time?
Have you ever used tobacco in any form?
When was the last time?
Have you ever been expelled, dropped, or suspended by any school or college?
Have you ever been arrested for any reason?
Have you ever been accused or convicted of any improper relation with a minor?
Is there anything else in your background about which we should know?
Please explain:
Comments or Additional Information
