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Admission Application

State* Zip*

 U.S. Citizen Permanent Resident Other

 AM Classes PM Classes

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian/Pacific Islander
Hispanic/Latino
White
Undisclosed

 Male Female

Emergency Contact

 Father Mother Guardian Other (please Specify)

State Zip

Do you have any special needs of which you would like us to be aware?  Yes No

Have you ever been convicted of a felony?  Yes No

If you marked yes to either of the above please explain

Honor Code

As a matter of personal commitment student, staff, and faculty of Eagle Gate College agree to abide by high moral values on campus (including grounds) which include being honest, respecting others and their property, obeying the law, and using appropriate language. They also agree to abstain from alcoholic beverages on campus
and to smoke in designated areas only. A student is considered to be in violation of the honor code if under the influence of alcohol or drugs while on campus, on campus grounds, or on internship/externship. Any member of the Eagle Gate College community caught selling or using illegal drugs on or off campus will be immediately terminated fr0m Eagle Gate College.

By typing my name below, I HEREBY make application for Admission to the College.

Date*