Akolouthia Institute - Adult Student Application

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Akolouthia Institute Adult Student Application

APPLICATION PROCEDURES

Please complete the entire application form and submit on-line by pressing the "Submit" button below.

PERSONAL INFORMATION

Akolouthia Institute admits students regardless of race, color, religion, gender, age, national and ethnic origin, disability, or sexual orientation.

First Name

Last Name

Are you a US citizen?

If no, Country of Citizenship

If no, Are you a permanent resident?

Gender

Female

Male

Marital Status	Married Single

Military Service?	N	Y	If yes, Branch of Service
Spouse or Dependent of a Veteran			N	Y

Background Information
Are you presently or have you ever been under suspension or dismissal for disciplinary and/or academic reasons from any college, university, or other formal post-high school education program?	N	Y
If yes, please provide an explanation below.
Have you ever been convicted of, or pled guilty or no contest to, a felony or misdemeanor charge (other than a minor traffic violation), or are charges pending against you?	N	Y
If yes, please provide an explanation below.

ACADEMIC INFORMATION


Applying as:	First Time Student	Continuing

I plan to pursue a:	Bachelor's Degree	Associate's Degree	Non-Degree Seeking

I plan to attend:	On-Line	Classrooms	Both

I plan to attend: (mark all that apply)	Day	Evening

Date of high school graduation or GED (if applicable)

What Classes Are You Interested in Taking at Akolouthia Institite?
*Choice*

Please list all high schools, colleges, or universities you have attended, beginning with the most recent:

Did you leave your prior institutions in good academic standing?

If no, please explain.

EMPLOYMENT INFORMATION

Current Employer			Start Date
Job Title			Shift

Please list past employer if current employment is less than 5 years.
Past Employer			Start Date

FINANCIAL INFORMATION

Does your employer offer Tuition Reimbursement?		Y	N
If yes,what percentage?	%

GENERAL INFORMATION

How did you learn about Akolouthia Institute?

What are your educational and career goals?

What influenced your application to Akolouthia Institute?

Please list any relatives who attended or are attending Akolouthia Institute

APPLICANT STATEMENT

I certify that the information given on this application is complete and accurate to the best of my knowledge, and that I am attending or have attended all colleges, or universities listed on this form. I understand that any misrepresentation on this form could render me subject to immediate dismissal from the College.

Name of Applicant	Date

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