Adult Degree Completion Program
Application for Admission

Term you wish to enroll:

Fall Spring Summer

Campus you will be attending?

Bay Minette Brewton Birmingham—Center Point Birmingham—Pell City Birmingham—Shelby Enterprise Daphne Montgomery

If attending the Pell City location, which concentration are you planning to enroll in?

I am not attending the Pell City location Management Health Care Management

Applicant Information

Mr. Ms.
Last Name	First Name	Middle Name
Preferred Name	Maiden and/or Previous Last Name(s)
Date of Birth
Month January February March April May June July August September October November December / Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920

Contact Information

Address
City	State
	Unselected Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Email	Home Phone
Work Phone	Cell Phone
Citizenship
U.S.
Other (Please Specify)

Optional Information

The information in this box is voluntary and is used for institutional research and federal reports only. It will in no way affect your admissibility or be used in a discriminatory fashion.

Marital Status

Select Single Married Divorced Widowed

Do you consider yourself to be:

Hispanic/Latino  NOT Hispanic/Latino

Additionally, please select one or more of the following racial categories to desribe yourself:

White Black or African American Asian American Indian or Alaskan Native Native Hawaiian or Pacific Islander (Ctrl + Click to select multiple items)

Religious Preference

Do you have at least three years of work experience?

Yes  No

Do you intend to apply for Financial Aid?

Yes  No

Will you be seeking Veteran's Benefits?

Yes  No

Academic Information

High School
City	State	Year of Graduation
	Unselected Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

List attended Universities, Colleges, or Community Colleges

Name	City	State	Credits
		Unselected Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
		Unselected Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
		Unselected Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
		Unselected Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

If applicable, please list any military training courses and mail or fax a copy of your DD214 form and other appropriate military records required to evaluate military credit.

If you have taken college credit tests such as CLEP, DANTES, USAF, official test results must be sent directly to Huntingdon College.

Where did you first learn about the Huntingdon Adult Degree Completion Program?

Please Read

To the best of my knowledge the information I have provided on this application is accurate. I understand that falsifying information can jeopardize my admission into the Huntingdon Adult Degree Completion Program.

I agree