Adrian College - Application for Enrollment
CANADIAN STUDENTS ONLY

Please complete this form only if you are a Canadian Citizen. If you prefer to print, fill out, and mail an application, please download our printable application and follow instructions.

If you are not a Canadian citizen, please complete the appropriate application:


Personal Information
First Name:
Last Name:
Preferred Name:
Address:
City:
Province:
Postal:
Home Phone:
E-mail:
SIN:

I am a U.S. Citizen
I am a permanent US Resident
Country of Citizenship
Country of Birth
Date of Birth (MM/DD/YYYY):
Sex:
Marital Status
If you currently hold a U.S. Visa, indicate type:
Expiration Date:

Optional Information
Race Asian    White   Hispanic/Latino
    please check Native Hawaiian or Other Pacific Islander
    all that apply Black or African American
  American Indian or Alaska Native
Religious Preference


Family Information
I live with:
Father's/Stepfather's/Guardian's Name
    Address (if different)
    College Attended
    Degree Obtained
    Employer
    Occupation
    Work Phone
    E-mail Address
Mother's/Stepmother's/Guardian's Name
    Address (if different)
    College Attended
    Degree Obtained
    Employer
    Occupation
    Work Phone
    E-mail Address
Brothers and Sisters currently attending college:
Name: College:
Name: College:
Relatives or friends who have attended or are attending Adrian College:
Name:         
Relationship: Attending Attended  
Name:         
Relationship: Attending Attended  

Academic Information
Top Choice Major #1
Top Choice Major #2
I plan to enter in:
I am applying as a:

High School Information

High School Name:
Graduation Year
Public or Private School?
Address:
City:
Province:
Postal:
Name of Guidance Counselor
His/Her Office Phone Number:
His/Her Office Fax Number:

College Information

Colleges attended (if any):
College most recently attended:
Date attended:
Degrees earned:
Total transfer hours completed:
Total transfer hours now enrolled:
Cumulative GPA
Anticipated GPA

Test Record
I have taken the ACT
I have taken the SAT
I will retake the ACT Date
I will retake the SAT Date
The ACT College Code for Adrian is #1954. The SAT College Code is #1001

Personal Interests
Varsity Sports Played Football Baseball Soccer
  Softball Basketball Volleyball
  Golf Cheer/Dance Track/Cross Country
  Tennis Synchronized Skating Ice Hockey
Lacrosse Bowling  
Cocurricular Newspaper Radio Marching Band
  Theatre Choir Student Government
  Yearbook Other:
Student Organizations Community Service Honors Society Foreign Language
  Religious Life Other:

Financial Aid Information
I plan to apply for Financial Assistance
Through (ex.OSAP):



By pressing "Submit" you are hereby authorizing your high school to provide transcripts and test scores to Adrian College.

 

I certify that the information given on this application is complete and accurate to the best of my knowledge. I understand that all documents submitted become the property of Adrian College. I understand that the misrepresentation of information on this form could render me subject to immediate dismissal from the College.

 

ADRIAN COLLEGE | 110 S. Madison St. | Adrian, MI 49221
ADMISSIONS: 1-800-877-2246 | Switchboard: 517-265-5161

 MY ADRIAN
 

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