Apply for Admission to the Evening or Online Undergraduate Program at Catawba College

First Name:
Middle Name:
Last Name:
Preferred Name:
Date of Birth:
Email Address:
Home Phone:
Mobile Phone:
Permanent Address:
City:
State:
Zip Code:
County:
Country:
Ethnicity/Nationality:	White / Caucasian Hispanic or Latino Black or African American Asian American Indian or Alaskan Native Native Hawaiian/Other Pacific Islander Other
Gender:	Male Female Self-Identity
Marital Status:	Common law Married Single Divorced Widow Unreported Unknown Legally separated Registered partnership Companion/Partner Other Unmarried Separated Registered partner
Please Explain:
Have you ever been charged with a criminal offense?
	No Yes
Citizenship Status:	U.S. Citizen Permanent Resident International Applicant
Visa Classification:
Are you a U.S. Veteran?	No Yes
Anticipated Major:	B.A.E. - Birth to Kindergarten B.A.E. - Birth to Kindergarten 2nd Degree B.A.E. - Birth to Kindergarten Post Bac B.B.A. - Management B.B.A. - Information Systems B.B.A. - Professional Accounting B.B.A. - Undecided R.N. to B.S.N. R.N. to B.S.N. 2nd Bachelor Degree Lateral Entry Teacher - Non-Degree Seeking Non-Degree Seeking
License #:
State of Issue
Term of Entry:	January February March April May June July August September October November December Year:
Are you planning to file the Free Application for Federal Student Aid (FAFSA)?
	Yes No
You will enter as a:	Freshman Transfer Re-Entering Post-Graduate
Transferring from (list all):
Have you attended Catawba previously?	Yes   No   If yes, when?
High School:
Year of Graduation:
How did you hear about us?:
By entering your initials below, you indicate that all information submitted with this application is complete, correct, and honestly presented.
	Initials:
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