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ACE UNDERGRADUATE APPLICATION

Call 641-784-5196 or email Admissions@graceland.edu with any questions.

Student's Personal Information

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First Name:

 

Middle Name:

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Last Name:

 
  
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Address Line 1:

 

Address Line 2:

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City:

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State:

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Zip:

 
  
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Home Phone:

 

Cell Phone:

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Email:

 
  
 

Gender:



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Date of Birth:

Social Security Number:

Ethnic/Race/Residency Information

 

Are you a US Citizen?


 

What is your country of origin?

 

Please select the Race that best describes you:




Are you Hispanic/Latino?


Schedule of Courses

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Session:

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Year:

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Course Number:

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Meeting Time:

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Course Title:

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Credits:

 

Course Number:

 

Meeting Time:

 

Course Title:

 

Credits:

 

Course Number:

 

Meeting Time:

 

Course Title:

 

Credits:

 

Course Number:

 

Meeting Time:

 

Course Title:

 

Credits:

 

Have you taken courses through Graceland before?

 

Do you plan to attend more than one college this term?

 

What major or academic area most interests you?

 
  
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Student's Grade Level:

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Have you previously applied for admissions to Graceland?

 

What year?

 

How did you hear about this program?

CONTRACT

I understand that withholding information requested on this application or giving false information will make me ineligible for admission to Graceland University or subject to dismissal. I also understand that the submission of fraudulent academic records by a student for undergraduate admission, transfer of credit, or any other purpose shall be cause for dismissal from the University. I certify that the information given in this application is complete and accurate, and if admitted, I agree to comply with the regulations of the University.

PLEASE NOTE: Other admission requirements, as listed in the university catalog, must be met before your application is considered complete.

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APPLICANT'S NAME:

 

Date:

1/19/2020

SCHOOL DISTRICT INFORMATION

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Name of School District:

 
  
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Name of High School:

 
  
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School City:

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School State:

 
  
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School Contact Person:

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Title:

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Phone Number:

School districts will be expected to pay for all enrollments after Graceland's last day to drop without a "W".

School District Verification

I verify that the school has on file parental/guardian and student signatures verifying completion of Administrative Rules 281-22.3 and 281-22.6; that the student information is accurate, and the student identified is eligible for participation in the Postsecondary Enrollment Options Act.

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Signature of Authorized School Official:

 

Date:

1/19/2020
*

Title: