Midwestern College
www.midwesterncollege.org

New Student Application
General Information

Please complete the following Course Application Form

Campus
First Name
Middle Name
Last Name
Gender Male Female
Home Phone
Cell Phone
Ethnicity
Birth Date
Street
City
State/Province
Zip/Postcode
Country
Email


Which of the following test have you ever taken?

GEDYes    No    Not Selected
ACTYes    No    Not Selected
SATYes    No    Not Selected
Work-keysYes    No    Not Selected

List in order from high school and all Colleges, Universities, Vocational schools, Private schools, etc you have attended.

List of high schools or Colleges you have attended.

Name of school
City and State
Name of school 3
City and State
Name of school 2


I hereby make application for selection to Midwestern College and I attest that the information on this application is complete and accurate. I understand that any misrepresentation, falsification, omission of information or any other attempt to deceive a school is a cause for either denial of selection for entry or dismissal from enrollment and that any future application(s) shall not be considered by Midwestern College. In addition, I also hereby give Midwestern College permission to conduct a criminal check on my background if need be.


Enter the above code
 Required