Pre-College and Special Student Application Form

Applicant Type for Course Enrollment

About You

First Name

Middle Name

Last Name

Birthdate

Gender

Year of High School Graduation

School Currently Attending

Contact Information

Email Address

Home Phone Number

Phone Number

Cell Phone Number

I agree to receive text messages from Bethel College

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Mailing Address

Country

Street

City

Region

Postal Code

Application Information

Enrollment Term

Course Selection: Please list what course(s) you would like to be enrolled in.

Voluntary Section
Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Are you Hispanic or Latino?

Yes

No

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Criminal History

Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from the 9th grade forward (or the international equivalent), whether related to academic misconduct or behavior misconduct, that results in your probation, suspension, removal, dismissal or expulsion from the institution?

Yes

No

Have you ever been convicted of a misdemeanor, felony or other crime?

Yes

No

Authorization for release of unofficial transcript to high school if enrolled for dual credit:
With your written permission, as indicated below, we will send an unofficial transcript (grade report) to your high school.

I authorize Bethel College to release an unofficial academic transcript to:

In place of your signature, please type your full legal name:

Alert

Pre-College and Special Student Application Form

About Bethel

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