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Application Form

Personal Information

Social Security Number (Submitting your Social Security Number (SSN) is not required, and your SSN will not be used to create a student identification number, but it is required to receive certain federal tax benefits. Your SSN is also helpful to accurately match records like SAT or ACT test scores.)

Please provide us with the email address you use most often.

Please provide your regular, primary phone number.

Please provide your personal cell phone number. If this is the same as your primary phone number, leave this line blank.

 

Address




(This is used for government reporting requirements only. No admission decision is based on this.)

(This is used for government reporting purposes only. No admissions decisions are based on this.)

High School Last Attended

(Currently attending or the last one you attended.)


Please indicate your top two sports (you played in high school or at a competitive level) that you would like to pursue at Ancilla College.

Please pick only one option.

Please pick all that apply.

Emergency Contact Information

Please provide Emergency Contact's regular, primary phone number.

Please pick all that apply.

 

Accuracy Statement

I certify that the information provided on this application is accurate and true. I understand that falsified information may result in denial of admission and termination of enrollment at Ancilla College. I agree to abide by the policies, rules and regulations of Ancilla College. I authorize my high school, and any other educational institutions attended, to furnish all academic and personal information information requested by the Ancilla Admissions Office. I authorize Ancilla College to report my academic progress to my counselor and program adviser for the purposes of curriculum and instructional development. I authorize the Office of Financial Aid to release appropriate information on my academic progress, including grades, and the amount of any aid and award I receive to state, federal and other agencies, institutions, and others involved in providing funds for my education.

E-Signature Name*