Evening and Weekend College Application

EVENING AND WEEKEND COLLEGE APPLICATION

BIOGRAPHICAL INFORMATION

PERMANENT ADDRESS

PERSONAL INFORMATION-FOR REPORTING PURPOSES ONLY

Virginia Intermont College does not discriminate either in the admission of students or in any of its policies, programs, or activities on the basis of race, religion, color, sex, national or ethnic origin, disability, sexual orientaion, or age
Are you Hispanic or Latino?
Regardless of how you responded to the prevous question, please select one
Religious Affiliation
Is your church a member of the Baptist General Association of Virginia?
Date of Birth (mm/dd/yyyy)(required)

EDUCATION INFORMATION

ENROLLMENT STATUS INFORMATION

EMPLOYMENT INFORMATION

a requirement for admission into any of our programs is work experience ranging from 2-5 years. Please document this information for us, beginning with your present position.
Years at your current employer(required)
Current Employer Name(required)
Current Employer City(required)
Current Employer State(required)
Current Job Title(required)
Most Recent Previous Employer
Most Recent Previous Employer City
Most Recent Previous Employer State
Most Recent Previous Job Title

OTHER INFORMATION

Have you ever been convicted of a felony?
If yes, please provide a brief explanation
I give Virginia Intermont College permission to release my name, hometown, and major for publicity purpose (required)

Admission