Adrian College - Application for Enrollment
CANADIAN STUDENTS ONLY

If you prefer to print, fill out, and mail an application, please download our printable application and follow instructions.

If you are an international student (except Canadians), a non-traditional student, a re-entering student or a non-degree-seeking student, please contact the Admissions Office for the appropriate application. 1-800-877-2246.
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
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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