Application for Admission
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Application for Admission

Term of Entrance



Spring 2008


Full Time

Fall 2008/09


Part Time

Spring 2009



Full Legal Name

Last:
First:
Middle:
Maiden:
 Name you prefer to be called:
E-mail Address:

Home Address
Street:



 City:
 State:
Zip:

Mailing Address
Street:



 City:
 State:
Zip:

General Information
Telephone Number:

Work Telephone Number:

 Sex:
Male Female 		Social Security Number:
Church Affiliation:

Date of Birth:

mm
 dd
 yyyy
 Place of Birth:
 Racial/Ethnic Group:

(Note: Response to this question is voluntary. The information provided will not be used in a discriminating manner, and results will be used for state and federal reporting purposes only.)

County of residence:
 Country of citizenship:
Marital Status:
Single
Married Name of spouse:
Separated
Divorced

Academic Information
What academic major are you considering? (if undecided, please state)
What career(s) are you considering? (if undecided, please state)

High school name:
public private parochial
High School Address:
City:
 State:
 Telephone Number:
High School Counselor:
 Year of graduation:

Do you plan to take the ACT? yes no
When?
If already taken, what was your composite score?

Do you plan to take the SAT? yes no
When? mm dd yyyy
If already taken, what were your scores? Verbal Math

Family Information
Father's Information
Last:
First:
Middle:
Living?
yes no 		High School Graduate?
yes no
College(s) attended:
Degree:
Occupation:
e-mail: 		Employer:

Business Phone:

Mother's Information
Last:
First:
Middle:
Living?
yes no 		High School Graduate?
yes no
College(s) attended:
Degree:
Occupation:
e-mail: 		Employer:
Business Phone:
Do you live with both parents? yes no, I live with
Marital Status of parents:
Single
Married
Separated
Divorced
Widowed
Name of legal guardian if different from above:
Last:
 First:
Middle:
Street:
City:
 State:
Zip:
Please list Name, Age and School Attending for each sibling:
Name:
 Age:
 School Attending:
Name:
 Age:
 School Attending:
Name:
 Age:
 School Attending:
Please list the name and relationship of any relatives who are MacMurray alumni:
Last:
First:
Middle:
Relationship:
 Class year:
Last:
First:
Middle:
Relationship:
 Class year:
Educational Objectives
Has your education been interrupted thus far for any reason? yes no
If yes, please explain:
Please list any activities or sports in which you would like to participate:
How did you first hear about MacMurray College?
Did you participate in the MacMurray Programs for the Gifted (Prairie Scholars)?
yes no

Have you visited the campus?
yes If so, when? When?mm dd yyyy no

Have you talked with a member of the admission staff?
yes name? no

Have you talked with any MacMurray College Alumni?
yes name? no

Have you applied or do you plan to apply to other universities or colleges?
If yes, which one? no

If accepted for admission, will you require financial assistance?
yes no

If financial aid is requested, submit a Free Application for Federal Student Aid (FAFSA) to the Federal Student Aid Program. Forms are available at high school guidance offices and college financial aid offices.

Are you a veteran?
yes no 		Do you plan to live on campus?
yes no
Referred by:

Is this person a MacMurray College student?
yes
no

The Following Section to be Completed by Transfer Applicants Only

Have you taken courses at MacMurray College?:
yes no
If so, please indicate the last semester you attended MacMurray.
Last college or university attended:
 Major:
City:
 State:
Dates enrolled:
mm dd yyyy to mm dd yyyy
Did you receive financial aid?
yes no
Degree:
Please list any additional colleges or universities attended, including dates of enrollment.
College or university:
Dates enrolled:
mm dd yyyy to mm dd yyyy
College or university:
Dates enrolled:
mm dd yyyy to mm dd yyyy

All Students Please Read the Following Before Continuing

If my application to MacMurray College is accepted, I agree to carry out the requirements for graduation in effect at the time of my enrollment at the College and to abide by all regulations. I understand that my acceptance may be revoked at any time if pertinent information is found to have been falsified or withheld. I also understand that this application will be used by MacMurray College for admission and financial aid purposes and by faculty and administrative personnel for academic and counseling purposes.

By submitting this application, I certify that the information provided on this application is correct and complete and that I will report any change in my status to the Office of Admission.
If you have problems submitting your application via the Web, e-mail the admissions office at admissions@mac.edu.

 
   
   
 
   
             
       
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