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 ADMISSIONS APPLICATION

Scholarship Info:

Fast Web
www.fastweb.com

BrokeScholar
www.brokescholar.com

ONLINE PRELIMINARY APPLICATION
Filling out this form is your first step toward a rewarding future at Stautzenberger College.

*Indicates required field

If you have already been contacted by Stautzenberger, please select the admissions representative you spoke to, otherwise skip to the next section.
Admissions Rep:
*Campus:
   
*Beginning Term:
  
Personal Info
*Last Name:
*First Name
Middle Name:
Nickname:
Maiden Name:
(if applicable)
*Address:
*City:
*State:
*Zip:
*Telephone: (XXX) XXX-XXXX
Unlisted Number
*Email Address:
Best Time to Meet/Call:
Weekday - Daytime
Weekday - Evening
Saturday
*Gender:
Female Male
*Date of Birth:

**The following fields are optional and the information provided here is for federal statistical reporting purposes only and will not affect the admissions process.
Marital Status:
Ethnic Group:
Citizenship:
Nationality:
(if not a US citizen)
Are you a Veteran? Yes No
 
*Are You Employed? Yes        No
Full-time     Part-time
Employer Name:
Employer Phone:
Employer Address:
Employer City:
Employer State:
Employer Zip:
*Program of Study:
*Educational Goal:
*Do you Plan to Attend Classes?
    
 
Education:
  
High School:
H.S. Address:
H.S. City:
H.S. State:
H.S. Zip:
*Graduation Date:
GED Holder (if applicable)
  
List any college/university attended (including Stautzenberger College)
Name:
City:
State:
Zip:
Attended:(mm/dd/yy)
 to
Degree Earned:
*How did you hear about us?
***This is only a preliminary application that will be reviewed by our admissions department. An admissions representative will contact you as soon as possible regarding your application
 

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