Today's date  MM-DD-YYYY  

 Term of entry  Fall Spring Summer     Year of entrance  YYYY 

  Entry Status  First-time freshman Transfer Re-admit Other first-time freshman (more than 1 year out of high school)    Full-time (12-18 credits) 3/4 time (7-11 credits) Half-time (1-6 Credits)

   If transfer, # of credits

 Ever attend PC?  When?

 Campus location  Aberdeen     Eagle Butte     Fairmont, MN     PC Virtual (on-line/distance education)

 Primary Course of Study

 Aberdeen Campus  Undecided B.S. in Biology B.S. in Business B.S. in Nursing B.S. in Radiologic Technology B.S. in Recreation B.S. in Social Work A.S. in Biology A.S. in Business A.S. in Chemistry A.S. in Communication A.S. in Early Childhood Education A.A. in English A.A. in General Studies A.S. in Medical Assisting A.A. in Religious Studies A.S. in Surgical Technology

 If Biology:  What are your career goals?

 Lakota Campus (Eagle Butte)  Undecided B.S. in Business B.S. in Social Work A.S. in Business A.S. in Early Childhood Education A.S. in Nursing

 Fairmont Campus  Undecided B.S. in Biology B.S. in Business B.S. in Nursing B.S. in Radiologic Technology A.S. in Business A.S. in Medical Assisting A.S. in Surgical Technology

 PC Virtual (on-line/distance education)    Choose one of the following B.S. in Business Completion (must have an Associate Degree in any field) B.S. in Nursing LPN to BSN (Degree completion for currently licensed LPN's) B.S. in Nursing RN to BSN (Degree completion for currently licensed RN's) B.S. in Radiologic Technology (Degree completion for currently registered RTs) B.S. in Social Work (Degree completion for Kilian Community College students) B.S. Business Completion (Degree completion for Kilian Community College students) A.S. in Medical Office Administration Certificate Medical Transcription

 Contact Information

 First Name            Middle Initial            Last Name   

 Mailing Address 

 City            State/Providence            Zip/Postal Code 

 Country 

 Home Phone (xxx-xxx-xxxx)            Work Phone (xxx-xxx-xxxx) 

  Employer            Position 

  Email Address 

 Additional Information

 Date of Birth  MM-DD-YYYY             Gender    Male  Female        

 Ethnicity            Social Security Number          

  Marital Status  Single Married Seperated Divorced Widowed           Other Name              

  Number/Age of Dependents        Religious Preference                     

 Parent/Guardian Information (Please complete if under 21 years of age)

 Father/Guardian's Name 

 Address (if different from applicant) 

 Profession/Position 

 Employer            Work Number   

 Highest Level of Education Completed     

 Mother/Guardian's Name 

 Address (if different from applicant)   

 Profession/Position 

 Employer            Work Number 

 Highest Level of Education Completed 

 Parents Marital Status  Married Divorced Seperated Single Widowed         With whom do you reside?  Both Mother Father Other

 Other Information

 Do you qualify for VA benefits  Yes  No

 Are you a U.S. Citizen?  Yes  No   If no, specify country of origin 

 International Students Only:

  Native language 

  Visa Type/Number/Expiration Date 

 Student Housing-Aberdeen Campus Only

All first and second year students under the age of 21 must live in the college suites.  If you wish to live off campus or with parent, a petition of waiver must be submitted and approved by the Dean of Students.

  I plan to live    In the Student Suites      Off Campus     With Parent/Relatives

 Academic Record-Must be completed before application can be processed

  Name of HS/GED/College            City/State            Dates attended (MM/YY)      Degree           Credit hours

*Applicants must submit official transcripts of all high school, college, and technical school credits earned and/or GED scores.  Official transcripts must be sent directly from all previously attended institutions to the Presentation College Admissions Office.

 Presentation College is my First Second Third choice.

 List other colleges to which you are applying

 College Athletics - Aberdeen Campus Only 

 Are you interested in playing college sports?  Yes     No

 Has a coach contacted you?  Yes    No   

 Which Coach?      

 Extra-curricular Activity Participation

 List high school activities in which you participated

Cheerleading

Newspaper

Drama

Student Government

Yearbook

Chorus

Band

Other (please list) 

 Presentation College is committed to a policy of non-discrimination on the basis of race, color, religion, age, national origin or disability in admission, educational programs or activities, and employment as required by applicable laws and regulations.  Responsibility for the coordination efforts and receipt of inquiries, including those concerning Title IX of the Educational Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973, has been delegated to the Director of Human Resources, Presentation College, 1500 North Main Street, Aberdeen, SD 57401/ 1-605-225-1634.  Presentation College Complies with the provisions of the Family Education Rights and Privacy Act of 1974 and the Student Right-to-Know Act of 1990.  The yearly report is available from the Dean of Students upon request.

By Submitting this application form, I affirm that the information provided on the application is accurate and complete.  Failure to provide correct information is grounds for reconsideration of this application.  If admitted, I agree to observe all the rules and regulations of Presentation College.

 Person Submitting            Date MM-DD-YYYY