Finalize your Direct Admission into Brevard College!

Direct Admission Information

Entry Status *

Personal Information

Entry Term *

Entry Year *

Primary Academic Interest *

First Name *

Middle Name

Last Name *

Name Suffix

Preferred Name

Social Security Number

This information is needed to process your financial aid awards and report your enrollment.

Gender *

Birth date *

Are you of Hispanic or Latino descent?

Yes

No

Ethnicity

Amer. Indian/Alaska Nat.

Asian

Black or African Amer.

Nat. Hawaiian/Pac. Islnd

White

Select one or more of the above.

Residency Information

Are you a U.S. Citizen?

Yes

No

If you are not a U.S. Citizen, please complete the following items:

Country Citizenship * Country Citizenship

Country of Birth Country of Birth

Current Visa Status in the U.S.

Number of years residing in the USA

Country Currently Residing In * Country Currently Residing In

Street Address *

Address Line 2

City *

County

State/Province * State/Province

State/ Province/ Other * State/ Province/ Other

Postal Code *

Phone Number *

Confirm Phone Number *

Email *

Confirm Email Address *

Optional Information

Religious Preference

Interests

Plan to Play Sports?

Yes

No

Recruited by a Coach?

Yes

No

Musical Ensemble Interest?

Yes

No

Voice Type *

Primary Performance Instrument *

Family Information

Parent/ Guardian 1

Parent/ Guardian 1 First Name *

Parent/ Guardian 1 Last Name *

Parent/ Guardian 1 Street Address *

Parent/ Guardian 1 City *

Parent/ Guardian 1 State/ Province * Parent/ Guardian 1 State/ Province

Parent/ Guardian 1 Zip/ Postal Code *

Parent/ Guardian 1 Country *

Parent/Guardian 1 Phone

Parent/Guardian 1 Email *

We only use this for communications about your application that have to be directed to your parent.

Parent/ Guardian 1 Relationship *

Parent/ Guardian 1 Education Level

Parent/ Guardian 2

Parent/ Guardian 2 First Name

Parent/ Guardian 2 Last Name

Parent/ Guardian 2 Street Address

Parent/ Guardian 2 City

Parent/ Guardian 2 State/ Province Parent/ Guardian 2 State/ Province

Parent/ Guardian 2 Zip/ Postal Code

Parent/Guardian 2 Country

Parent/ Guardian 2 Primary Phone Number

Parent/ Guardian 2 Email Address

We only use this for communications about your application that have to be directed to your parent.

Parent/ Guardian 2 Relationship

Parent/ Guardian 2 Education Level

Academic History

Be sure to list all institutions (high schools, colleges, universities, etc) that you have attended for 1 or more classes.

High School

High School Name *

High School CEEB Code

High School City *

High School State *

High School Graduation Date

Add a 2nd High School

College History

Taken College Course?

Yes

No

Attended Early College?

Yes

No

Attended Another College? *

Yes

No

College

College Name

College CEEB Code

College City

College State

College Graduation Date

College Dates Attended

ex.: 08/2013-06/2017

College Degrees Earned

Add a 2nd College

Additional Applicant Information

Disciplinary Dismissal? *

Yes

No

If Yes, please explain. *

Convicted of Crime? *

Yes

No

If Yes, please explain. *

Do you intend to Graduate from Brevard?

Yes

No

Other Colleges Applied To?

Where do you plan to live? *

Any further comments concerning your application

Condition of Admission

By submitting this form online you agree to the following:

I certify that all items of this form are answered correctly and completely. I understand that providing false or incomplete answers may disqualify me from admission to or terminate my enrollment at Brevard College. I understand that it is my responsibility to notify Brevard College promptly if there is any change in the information prior to my enrollment at Brevard College. I further give my high school permission to release my official transcript to Brevard College.

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