Fall 2002



Semester/Year

Fall ____

Spring____ |

Great Lakes Christian College

Limited Enrollment Registration Form

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ADMISSIONS INFORMATION

Name

Last First Middle

Social Security Number _______________________ Birth Date______________ Phone Number _

Mailing Address

Number and Street City State Zip Code

E-mail ___________________________________________ Occupation:

Marital Status: ( Single ( Married (Spouse______________________) ( Widow(er) ( Divorced

Church You Attend_________________________________ Minister’s Name

Address

Number and Street City State Zip Code

Phone ( ) ____________________ How frequently do you attend church?

Emergency Contact Person___________________________ Relationship___________ Phone ( )

Any special health concerns?

STUDENT STATUS:

( First Time Attendee ( Returning Last Semester Attended: (semester/year)

( Non-Degree (up to 12 hours) ( High School - Dual Enrolled ( Guest from Host School:

DEGREE GOAL: (Associates (Bachelors (Undecided Major Area of Study/Interest:

|DEMOGRAPHIC DATA (optional): |Religious AFFILIATION (optional): |

|Ethnic Group: | |

|( Native Hawaiian/Other Pacific Islander | |

|( Black/African American | |

|( American Indian/Alaska Native | |

|( Hispanic/Latino | |

|( Two or More Races | |

|( White | |

|( Asian | |

|Citizenship: Gender: | |

|( United States ( Male | |

|( Resident Alien ( Female | |

|( Non-Resident Alien | |

| |( Assembly of God |( Church of God |(Islam |

| |( Apostolic |( Community Church |( Nazarene |

| |( Baptist |(Disciples of Christ |( Non-Denominational |

| |(Catholic |( Evangelical Free |( Pentecostal |

| |(Christian Churches/ |( Jewish |( Presbyterian |

| |Churches of Christ |( Lutheran |( Seventh-Day Adv. |

| |( Christian Reformed |( Mennonite |( Wesleyan |

| |( Church of Christ |(United Methodist |( No Affiliation |

| |(non-instrumental) |( Free Methodist |( Other: ____________ |

|COURSE | |CREDIT | | | |SPECIAL * PERMISSION|

|NUMBERS |COURSE NAME |HOURS |DAYS |TIMES |ROOM | |

| | | | | | | |

| | | | | | | |

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* “Special Permission” is for professors to initial approval for internships or classes for which prerequisites have not been met.

Advisor’s Signature Total Credits Date

Student’s Signature Date

High school students who wish to enroll for up to 6 credit hours per semester may enroll using this registration form. After graduation, if you desire to continue taking classes, you must apply for full admission to the college. This process includes completing a regular application, paying the application fee, and having high school and other transcript(s) sent directly to GLCC.

Guest students who are participating in a cooperative program between GLCC and another institution must complete this registration form to enroll in GLCC classes. Other guest students may take up to 12 credits under this limited status. After 12 credits, you must complete the regular application process and be accepted as a GLCC student.

Have you been arrested for any criminal activity? ( Yes ( No If yes, give a full explanation of your activity and the case on a separate sheet of paper. Include the current status of your case. Great Lakes Christian College does not have a policy of excluding individuals based on this information, but will consider each case to safeguard the security of the College.

Great Lakes Christian College admits students without discrimination as to race, gender, or physical disability.

ENROLLMENT INFORMATION

List the high school where you graduated and any college you have attended:

High School Location Dates of Attendance Diploma

College Location Dates of Attendance Diploma

College Location Dates of Attendance Diploma

COMMUNITY AGREEMENT

Great Lakes Christian College seeks to provide a community atmosphere where students can “Love the Lord your God with all your heart and with all your soul and with all your mind.” (Matthew 22: 37). As a part of this community, each person agrees to uphold an atmosphere of spiritual growth, evangelism, servanthood, respect for all individuals, moral and physical purity, honesty, integrity, and responsibility. If accepted as a student, I am willing to abide by this community agreement and all other guidelines set forth in the Catalog and Student Life Handbook.

(Under the Family Education Rights and Privacy Acts of 1974, which gives students the right to examine their education records, students may waive their right to see specific confidential statements and letters of recommendation. In the belief that applicants and the persons from whom they request recommendations may wish to preserve confidentiality of the reference questionnaire, the College gives students the right to waive their right to examine questionnaires received.)

I hereby grant permission to Great Lakes Christian College to contact the minister of the church listed on this application. I agree that any such contacts shall not be regarded as an invasion of my privacy.

I now affirm all the information on this application to be correct and true.

Signature Date

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Registration is not complete until financial arrangements have been made with the

GLCC Business Office

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