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Admissions Application

Intended Entry Term/Year: *

Campus Attending: *

St. Martin

Cincinnati

Other Site

Concentration:

Business

Early Child. Edu

Human Services

Liberal Studies

Graduation or Expected Graduation Year: *

High School Attended: *

Personal Information

Gender: *

Female

Male

First Name: *

Middle Name:

Last Name: *

Maiden Name:

Email Address: *

Street Address: *

Apt. Number:

City: *

State: *

Zip Code: *

Phone: *

Alternate Phone:

Birthdate: *

Citizenship:

U.S. Resident

U.S./Dual Citizenship

Educational Goals: *

Chatfield Associate Degree

Bachelors or Associate Degree elsewhere

Not seeking a degree

Highest Education Received: *

High School Diploma

GED

Some college

(Please check all that apply)

Military Experience: *

Yes

Financial Aid

Do you wish to apply for Financial Aid?: *

Yes

Academic History

High School:

Graduation Date:

GED Center Address:

GED Date:

Employment

Employer:

Work Phone:

Does your employer offer tuition reimbursement? :

Yes

How did you hear about Chatfield College?:

Equal Opportunity Policy:

Chatfield College subscribes to Equal Opportunity/Affirmative Action guidelines and does not discriminate in its education programs or activities on basis of race, color, creed, sex, national origin or handicap, in accordance with both Title IX of the 1972 Education Amendments and Section 504 of the Rehabilitation Act of 1973. Inquiries regarding compliance with the Title IX and Section 504 may be directed to Chatfield College, 20918 St. Rt. 251, St. Martin, OH 45118-9705; Phone 513.875-3344.

Submit Admission Application

I certify that the information contained in this application is true and correct. I understand that misrepresentation or omission of information, such as failure to list all schools, colleges, or universities attended, may result in the denial of this application or subsequent dismissal from the college and loss of credit.