Williams Baptist College

July 4, 2008

Application For Admission

Admission Status

Date of Entry	Classification	Housing Plans

Personal Information

Last Name/Surname First Name Middle

Maiden Name Preferred Name

Under what other name might we receive information?

Are you a United States Citizen? Yes No

SS Number (XXX-XX-XXXX)

Male

Female

Date of Birth

Email Address:

Mailing Address County

City State Zip Phone

Do you plan to apply for financial aid? Yes No

Have you visited Williams? Yes No

Ethnic Background (optional):

Are You Single Married - Spouse's Name:

Family Information (for dependent students only)

Check if: mother is deceaseed father is deceased
parents are divorced father is remarried mother is remarried
If parents are divorced, parent with whom you live

Father's Information	Mother's Information
Name in Full:	Name in Full:
Address:	Address:
Phone:	Phone:
Title/Occupation:	Title/Occupation:
Employer:	Employer:
College and Degree:	College and Degree:
Who should be contacted in case of any emergency? Name and Phone
Siblings:

Church Information

Church member? Yes No If Yes, what denomination?

Church Name:

Address: City: State: Zip:

Are you planning to pursue a church career? Yes No

If yes, what type of ministry?

Academic Information

Name of High School (or GED): Graduation Date:

City: State: Zip: Country:

What type of school? G.P.A. on a

ACT Composite SAT: Verbal Math:

Do you plan to retake the ACT or SAT? When?

Are you seeking a degree from Williams Baptist College? Major:

To which other colleges or universities will you apply?

Transfer Information

Are you presently attending any college or university? Yes: No:
Please list ALL institutions, locations, and dates you have attended. Failure to provide a list of all colleges attended (including correspondence and extension courses) may result in delay of admission, loss of credit, and/or dismissal. It is the applicant's responsibility to have official transcripts forwarded from EACH college attended. An official transcript is required even if attendance was for a brief time and even if no credit was established. Please list in descending order beginning with the current or most recent college or university.

Name of Institution	City and State	Dates Attended	No. of Credits	G.P.A.

Academic Honors/Extracurricular Activities

Briefly describe any School, church, or civil honors that you have received and list any extracurricular activities including sports in which you have participated.

Please check the activities in which you would like to participate at Williams.

Basketball (men & women)	The Cast	Williams Singers
Baseball (men)	Drama	Missions
Volleyball (women)	Cheerleading	Bible Studies
Golf (men)	Campus Ministries	International Club
Softball (women)	Student Government	Social Clubs
Soccer (men)	FCA	Intramural Sports

Verification

Have you ever been convicted of a crime higher than a traffic violation?
Yes No (If yes, please explain in detail.)

Submission of this form certifies that the information herein is complete and correct and that all attended educational institutions are specified. Falsification of any information on this form could result in dismissal from Williams Baptist College.

Select here to proceed then click SUBMIT below.

Note: Any student who makes application to Williams over the internet will have his/her application fee of $20 waived.

Williams Baptist College • 60 W Fulbright Avenue • Walnut Ridge, AR 72476 • (870) 886-6741 • fax (870) 886-3924