Application for Admission Continuing Education Students age 23 and older If you need help or have any questions, please call us at: 1-800-3303 ext. 5200 or 712-279-5200 General Information Check the term you want to begin Fall Semester Spring Semester Summer Status (Check all the items that will pertain to you) Full-Time Part-Time Daytime Online Personal Information First Name Middle Name Last Name Home Address City State Zip Home Phone Cell PHone Social Security Number Date of Birth (mm/dd/yyyy) City of Birth State of Birth Country of Birth If you are a permanent resident alien (PRA, list your PRA Number. Marital Status Maiden or Former Name Gender: Male Female E-mail Address Ethnicity & Race Select one or more of the following racial categories: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander Hispanic / Latino White Religious Affiliation (Optional) Military Experience Veteran Non-Veteran Employer Office Phone Can you conveniently receive calls at work? Yes No Have you ever been on disciplinary probation by a college or university? Yes No Have you ever been suspended or dismissed from a college or university for disciplinary reasons? Yes No Education GED Yes No      Date Recieved College and Other Schools (including military training) School City State Years Attended  to  to  to  to  to High School Address City State Zip Code Phone Number Graduation Year High School Guidance Counselor What motivated you to contact BCU? Word of Mouth Direct Mail Internet/Website TV Ad Radio Ad Newspaper Ad What most influenced you to apply at Briar Cliff? Do you plan to apply to other colleges (please list in order of preference below)? Career Interest Major field of academic interest Career Plans Activities Please list church, community, and athletic activities Which activities and/or sports do you wish to participate in at Briar Cliff? Financial Assistance / Scholarships Do you plan to seek financial assistance? Yes No Do you plan to audition for theatre scholarships?Yes No Do you plan to audition for music scholarships?Yes No Do you plan to submit an art portfolio?Yes No Do you plan to try out for an athletic scholarship?Yes No Does your employer offer tuition benefits?Yes No If yes, in what amount? What are the conditions for receiving the benefits? Family Information Relatives who attended or currently attend Briar Cliff University Last Name First Name Relationship Year Attended To be considered for acceptance, you must submit the following. Completed Application for Admission All official high school and college transcripts If you received a GED, please provide an official copy of the results A non-refundable fee of $20 Please submit all of the above to: Briar Cliff University Office of Admissions 3303 Rebecca Street Sioux City, IA 51104 Copyright 2010 by Briar Cliff University