| Personal Information |
| First/Middle/Last Name: |
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| Social Security Number: |
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| Date of Birth: |
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| Preferred Method Of Contact: |
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| E-mail address: |
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| Gender: |
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| Religious Affiliation (optional): |
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| Are you a US Citizen? |
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| If no, of what country are you a citizen? |
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| Resident Alien Number: |
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| Visa Status: |
Other: |
| What brought about your interest in Cedar Crest College? |
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| If you visited Cedar Crest, when and on what occasion? |
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| What are the most important factors in your college selection? Hold CTRL and click to select multiple values. |
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| To what other colleges do you plan to apply? |
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| Entry Information |
| Term you wish to enter: |
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| Will you: |
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| Will you enter as: |
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| To help us report on cultural diversity, we ask students to self-identify. Please mark the appropriate choice. (Answering this question is voluntary and optional and this information will not be used in our admissions decision.): |
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| Academic Area of Interest or Career Objectives |
| Academic or Career Interest (First Choice): |
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| Academic or Career Interest (Second Choice): |
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| Educational Background |
| Name of High School: |
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| Year of High School Graduation: |
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| High School Address: |
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| High School City/State/Zip: |
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| High School County: |
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| High School Guidance Counselor Name: |
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| High School Phone #: |
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| Please name any college attended: |
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| Dates Attended: |
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| Degrees Earned: |
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| My Interests Include: |
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| I played the following varsity sports in high school: |
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| Please list any other activities, honors, community service, sports, and work experiences: |
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| Have you participated in a Hugh O'Brian Youth (HOBY) Leadership Program? |
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| Are you a graduate of a Governor's School of Excellence Summer Scholarship Program? |
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| Have you received your Girl Scout Gold Award? |
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| Are you a child or a grandchild of a Cedar Crest graduate? |
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| If yes, name of parent or grandparent who graduated from Cedar Crest and their graduation year: |
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| Family Background |
| Mother/Guardian Information |
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| Prefix: |
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| First/Last Name: |
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| Mother/Guardian Email: |
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| Mother/Guardian Information |
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| Street: |
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| Home Phone #: |
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| Business Phone #.: |
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| Occupation: |
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| Company Name: |
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| Did your mother graduate from college? |
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| If yes, from where? |
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| Father/Guardian Information |
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| Prefix: |
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| First/Last Name: |
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| Father/Guardian Email: |
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| Father/Guardian Information |
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| Occupation: |
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| Company Name: |
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| Did your father graduate from college? |
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| If yes, from where? |
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| Siblings' Names and Ages: |
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| Please list any other relatives, friends, or teachers who have attended or who currently attend Cedar Crest College. Indicate their relationship to you and their class year, if known: |
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Cedar Crest College complies with all applicable federal
and state legislation and does not in any way discriminate in educational
programs or in employment on the basis of religion, national origin, race, age,
gender, disability, or sexual orientation.