Accelerated Degree Program

Application for Admission

I. ABOUT YOU
First Name*
 Middle/Maiden Last Name* Preferred Name

If you have attended any school under any other name(s) not listed above, please list them in the field below.  Seperate multiple names with a comma.

Social Security Number* (xxx-xx-xxxx)

PERMANENT ADDRESS:
Street *
 City*
 State*
 Zip*

TELEPHONE NUMBERS:
Home* (xxx-xxx-xxxx)
 Daytime (add extension if applicable)

E-mail Address*

Present Employer
II. DEGREE PLANS
ENROLLMENT DATE:
Session*
 Year*

Desired Major*
III. SELF-REPORT INFORMATION
 
Birthdate*
 Gender
Male Female		 Marital Status

Ethnic Background
White Non-Hispanic
Black Non-Hispanic
Hispanic
American Indian or Alaskan Native
Asian or Pacific Island
Other

Citizenship*
U.S. Citizen
Foreign Permanent Visa Other:
Other
Country of Birth

The financial support that Mississippi College receives from the Mississippi Baptist Convention is based on a formula that includes data about church affiliation.  We need your help with the following information:

Denomination

Current Home Church
Church City
Church State

IV. ACADEMIC DATA

Please list the most recent educational institutions you attended.  You will need to order a transcript from ALL institutions attended and have them sent to:
Mississippi College - ADP Box 4026, Clinton, MS 39058

COLLEGE/UNIVERSITY #1:
Name
City
State
 Years Attended
Degree Received Major    

COLLEGE/UNIVERSITY #2:
Name
 City
 State
 Years Attended
Degree Received Major    

COLLEGE/UNIVERSITY #3:
Name
City
 State
 Years Attended
Degree Received Major    

If you have not earned any college credit, please tell us where you went to High School:
High School Name
City
 State

 

V. OTHER INFORMATION

Have you ever been convicted for anything other than a minor traffic violation? *
 Yes No
If yes, please give date and nature of offense

How did you find out about our New Accelerated Degree Program?


If you chose "Radio Station", "Television", or "Newspaper", please tell us on which station or newspaper you heard or saw the advertisement; if you chose "Other", please tell us where:


VI. ELECTRONIC SIGNATURE
If admitted to Mississippi College, I agree to abide by the policies and provisions stipulated in the College Bulletin and Student Handbook and/or other official publications authorized and approved by the College.

I affirm that the information given in this application is accurate and complete to the best of my knowledge. Mississippi College is a Baptist institution and does not permit possession of or use of alcohol or drugs while enrolled. I agree to conduct myself in accordance with the high standards of Mississippi College.

In lieu of a signature, please check if you agree to the statement above and state your full name.
Full Name:

The application process is not complete until all transcripts
are received by the Accelerated Degree Program Office.

 

Mississippi College considers qualified applicants without regard to race, sex, creed or national origin, age or handicap in its admissions policies and practices. Federal law expressly recognizes exemptions claimed by religious institutions.