Admission Application
    		 


    For online submission only. Please complete this form using the "TAB" key or your mouse to move to the next question. 
    * indicates required items.

    All new students must complete the following steps:

    1. Complete and submit this Application for Admission. 

    2. Complete, sign, and submit the Application for Admission Signature Page with a one-time non-refundable $20.00 application fee to:

      Admissions Office
      Jefferson College
      1000 Viking Drive
      Hillsboro, MO 63050

      Make checks payable to Jefferson College.

    3. Submit proof of high school graduation and/or college credit earned (see Special Student Admissions) to the Admissions Office.


    Admissions Application
       
    Use full legal name
    *First Name:
    Middle Name:
    *Last Name:
    Previous/Maiden Name:
    *Street Address 1:
    Street Address 2:
    *City:
    *State:
    *Zip Code:
    *County:
    E-mail Address:
    required for online enrollment
    *Home Phone:
    -  (please include area code)
    Work Phone:
    -  Ext. (include area code)
    Cell Phone:
    		 -  (please include area code)
    *Date of Birth:
    		 (MM/DD/CCYY)
    *Social Security #:
       
    *Are you a U.S. Citizen?
    Yes  No
    ( If no, please submit copy of I-151 or I-551)
    Place of Employment:
    Does your employer provide tuition assistance/reimbursement? YES NO
    **Questions regarding gender and race are important in determining the effectiveness of efforts related to the provision of equal educational opportunity.  This information is not used in determining admission to Jefferson College.
    **Gender:
    Are You Hispanic or Latino? YES NO
    **Ethnic Description:
    Student Status:
      Taking courses from Jefferson College to receive a degree, then transfer to another college.
      Taking courses from Jefferson College to complete a career and technical education program.

      Taking courses from Jefferson College to transfer to another college, but do not expect to graduate from Jefferson College.
      Transferring from another college to receive a degree from Jefferson College.

      Attending Jefferson College for personal interest only - not planning on receiving a degree. (Special Students are ineligible to receive federal aid).
     Other

    Have you previously attended Jefferson College?   Yes  No    


    If yes, did you participate in one of these programs?

    High School Area Technical School

    High School Dual Enrollment

    Student Classification:
    First-time freshman (never attended college before or may have participated in high school dual enrollment)
    Transfer student (have attended college previously at another institution)
    4 year college graduate
    2 year college graduate
    Other (Please explain)
    *Anticipated Start Term:
    Plan to Attend:
    Day or Evening:
    Preferred Location:
    Primary purpose for attending:

    How did you hear about Jefferson College?

    Would you like to receive more information regarding services for students with disabilities?

    Yes   No
     
    Have either of your parents earned a Bachelor's degree? Yes   No
    *Anticipated Degree & Area of Study:
    (Select only one choice of degree and area of study)
     

    Associate of Arts
    (A program of general studies designed to transfer to a four-year institution.)

                        Major:

    Associate of Arts in Teaching
    (A program of general studies and required education courses designed to transder to four-year institutions.)

    Associate of Science
    (Designed for transfer to an engineering institution. Pre-Engineering Majors only.)

    Associate of Applied Science
    (Career and Technical programs not generally designed for transfer.)

                       Major:

        **If Apprenticeship training, please indicate type

    Career & Technical Education Certificate
    (Completion of specific practical course work with little or no general ed requirements.)

                       Major:

    Fast Track/Dean's Certificate

                       Major:

    Non-Degree Seeking/Selected Courses
    (Course work designed for self-enhancement and personal interest.) 

    Undecided
     
    IMPORTANT:  
    Have you graduated high school or completed a GED test before the date of this application?
    If "YES", check and complete one of the following:
    		If "NO", check and complete one of the following:

    High School graduate (not home school):

    High School:

    GradYr:

    City:

    State:

    Still attending high school/home school but expect to graduate:

    High School:

     GradYr:

    City:

    State:


    Home School graduate:         Indicate GradYr:


    Still attending high school/home school but do not expect to graduate.

    High School:

    City:

    State:


    Passed GED test: 
            Indicate Month/Year


    Planning to earn GED: 
          Indicate Month/Year


    No High School Equivalency
    A+? 1. Is your high school a Missouri A+ designated high school?   
    Yes   No

    2.     If yes, do you anticipate meeting the criteria for the A+ schools scholarship? 
    Yes   No
    		Have you attended other colleges or universities?
    1. 
        
    2. 
        

    NOTE: 

    Please review all information entered above to confirm that it is correct, and make any necessary
    corrections before choosing "Submit."     

    Please note that the Signature Page must be completed, signed and sent to Jefferson College at the time that your application is submitted or mailed.

    Questions regarding this application or the content of this page should be directed toward the Office of Admissions, (636) 797-3000/942-3000, ext. 217