Fillable Conf Sponsored Employee AppfillablePDF (Southern College)

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Conf Sponsored Employee AppfillablePDF (Southern College)

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  • 80 other fields

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File type: PDF

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Conference-Sponsored Student Application
Please type or print clearly
Last/Family name First name
Middle name Social security number
Mailing address
City State ZIP code
Home telephone ( ) Work telephone ( )
Cell phone ( ) Email
Have you ever been convicted of a misdemeanor or felony? PYes PNo
If the answer is yes, please explain
Southern student ID # (if any)
FOR NON-U.S. CITIZENS ONLY
Country of birth Citizenship
Visa type
FOR STATISTICAL PURPOSES
Birth date (m/d/y) Gender PMale P Female Marital Status PSingle PMarried
Ethnic origin PAmerican Indian/Alaskan Native PAsian PBlack/African American PHispanic/Latino
PWhite PHawaiian or other Pacific Islander PTwo or more races
Conference of church membership Union
Have you attended Southern before? If yes, what is the date of your last attendance?
I plan to take my studies beginning P Summer 20 P Fall 20 P Winter 20
I plan to take
PGraduatePUndergraduate PBoth
PROGRAM DATA
For which program are you applying? (Please note specific program and concentration/emphasis, list attached)
P MA P MSEd PCertification Concentration/Emphasis
Anticipated location of enrollment (check all that apply) P On-campus P Online
EDUCATIONAL HISTORY
Please list all colleges and universities you have attended and degree conferred.
Name of institution
City, state, country
Attended from (m/y) to (m/y)
Degree and major completed
Date of conferral (m/y)
Name of institution
City, state, country
Attended from (m/y) to (m/y)
Degree and major completed
Date of conferral (m/y)
Other names(s) under which transcript may be issued
Yes
PLEDGE
I voluntarily agree to uphold the ideals, standards, and principles set forth in the Southern Adventist University Graduate/Undergraduate Catalog and Student Handbook
and pledge my cooperation and loyalty. Since Southern is a Seventh-day Adventist institution, I understand that the values and standards of the church are reflected in
the university rules and regulations.
I authorize the use and reproduction by the university, or anyone authorized by the university, of any images taken of me while enrolled at Southern, whether distrib-
uted by print medium, video cassette, CD, DVD, Internet, television or any other mode or medium, whether now existing or subsequently developed. All such images,
however stored, shall constitute Southern Adventist University property, solely and completely, and I shall be entitled to no compensation for the use of my image. This
authorization shall include without limitation university publications and advertising and classroom video taping.
I also understand that my signature below indicates that all the information given in this application is factually correct and honestly presented.
_______________________________________________________________________________________________________________________________ _________________________________________ ______________________________________________________________________________________________________________________________
Signature Date Print your full name
INSTRUCTIONS FOR GRADUAT E STUDENTS ONLY
To complete a graduate application, the following must be sent to Graduate Studies at Southern Adventist University. Refer to the Graduate Catalog
for additional admission prerequisites.
s /FlCIAL TRanscripts of undergraduate degree course work
s 4W O RECOMMENDATIONS FORMS PROVIDED
s  APPLICATION FEE DEGREE SEEKING
s '2% SCORE
School of Religion only
s )F A PASTOR WHAT YEAR DID YOU ENTER THE MINISTRY
Are you an ordained minister? P yes P no If yes, date of ordination?
Are you conference sponsored? P yes P no If yes, what conference?
DISABILITY SERVICES
Students with physical or academic disabilities that could impact their learning experiences, who qualify for accommodations or
SPECIAL SERVICES MUST CONTACT THE ,EARNING 3UCCESS #ENTER AT  3OUTHERN IS IN COMPLIANCE WITH 3ECTION  OF THE
Rehabilitation Act (1973) and is dedicated to the elimination of architectural and prejudicial barriers which prevent any qualified per-
son from attending.
MAIL OR FAX THIS APPLICATION FORM TO:
Graduate Studies, Southern Adventist University,
0OST /FlCE "OX  #OLLEGEDALE4.  53!
PHONE: 1.800.SOUTHERN FAX: 423.236.1694 EMAIL: graduatestudies@southern.edu WEB: www.southern.edu
(OFFICE USE ONLY)
ID
Amount
Receipt
Southern Adventist University is a private, Christian university. In a manner consistent with all applicable laws and regulations,
it is open to all and does not discriminate on the basis of age, gender, race, color, ethnic or national origin, or handicap in the
administration of its educational policies, programs, and activities including its admissions policies, financial programs, and other
university-administered programs.
Employing organization Title or office
Location Dates from (m/y) to (m/y)
PROFESSIONAL HISTORY
Please include present or most recent positions or jobs held. If you prefer, you may submit your current resume (use an additional sheet if needed).
APPLICATION DEADLINES
s Summer term – April 1
s &ALL SEMESTER n *ULY
s Winter semester – November 1
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Conf Sponsored Employee AppfillablePDF (Southern College)

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Completed 25 July 2020

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