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Online Application

The online application must be completed in one sitting.  It is recommended that applicants review the paper application prior to completing the online version to ensure all pertinent information is available.  Questions may be directed to Justin Bleeker, Director of Admissions.

Application for Admission

Please fill out all areas of the application completely before submitting.
1.
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I am applying for the:
2.
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First name:
3.
*

Middle initial:
4.
*

Last name:

Address Information
5.
*

Street Address:
6.
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City:
7.
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State/Province:
8.
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Zip/Postal Code:
9.
*

Country:
10.
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Home Phone (555-555-5555):
11.

Cell or Work Phone:
12.
*

E-mail Address:
13.
*

Date of Brith (mm/dd/yyyy):
14.
*

Gender:
15.
*

Marital Status:
16.

Spouse's Name (if applicable):
17.

Number of Children (if applicable):
18.
*

Citizenship (Name of country or countries):
19.
*

Have you ever been convicted of a legal offense other than a traffic violation?
20.

If yes, please explain:
21.

Do you have any physical conditions about which we should know to assist you at Providence? (optional)
22.

If yes, please explain:
23.

Ethnic Background (Optional- for statistical information only):

Enrollment Information:
24.
*

Admission Status:
25.

Possible area(s) of academic concentration/jaor:
26.
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Degree seeking?
27.

If yes, do you plan to graduate from Providence?
28.

If not, from which institution do you plan to graduate?
29.
*

Do you plan to live on campus or commute (all students under 21 years of age, who are not living with a parent/guardian, are required to live on campus)?
30.
*

Do you plan to apply for financial assistance to attend Providence Christian College?
31.

Name of the Providence admissions counselor you have worked with (if applicable):

Educational Information:

 
32.
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High school name:

High school address:
33.
*

Street address:
34.
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City:
35.
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State/Province:
36.
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Zip/Postal Code:
37.
*

Country:
38.
*

Graduation Date (mm/yyyy):

Indicate when youhave taken or plan to take the ACT or SAT I:
39.

ACT Date (mm/yyyy):
40.

ACT composite score:
41.

ACT English score:
42.

ACT Math score:
43.

ACT Science Score
44.

ACT Writing score:
45.

SAT I Date (mm/yyyy):
46.

SAT I composite score:
47.

Verbal score:
48.

Math score:
49.

Writing score:
50.

Indicate if you have earned any of the following that may be transferred for college credit (please send all official exam scores to the office of admissions):
Advanced placement courses
College Level Examination Programs
International Baccalaureate

List all college(s) previously attended and send an official copy of transcript(s)
51.

Institution #1:
52.

Institution #2:
53.
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Have you ever been refused admission, suspended, had your enrollment terminated, or been asked to withdraw by any college?

Church Information:
54.
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Church Name:
55.
*

Denomination:
56.
*

Street Address:
57.
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City:
58.
*

State/Province:
59.
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Zip/Postal Code:
60.
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Country:
61.
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Church Telephone (555-555-5555):
62.
*

Pastor's name:
63.
*

Which of the following applies to you?

Family Information:
64.
*

Father living?
65.
*

Mother living?
66.
*

Are your parents seperated or divorced?
67.

If yes, with whom do you live?

Paternal Parent or Guardian
68.
*

Check the appropriate category:
69.
*

Last name:
70.
*

First name:
71.
*

Middle initial:

Address (if different than yours):
72.

Street address:
73.

City:
74.

State/Province:
75.

Zip/Postal Code:
76.

Country:
77.
*

Telephone (555-555-5555):
78.

E-mail:
79.
*

Employer:
80.
*

Occupation:
81.
*

Highest educational level attained:

Maternal Parent or Guardian:
82.
*

Check the appropriate category:
83.
*

Last name:
84.
*

First name:
85.
*

Middle initial:

Address (if different than yours):
86.

Street address:
87.

City:
88.

State/Province:
89.

Zip/Postal Code:
90.

Country:
91.
*

Phone number (555-555-5555):
92.

E-mail:
93.
*

Employer:
94.
*

Occupation:
95.
*

Highest educational level attained:
96.
*

How did you hear about Providence Christian College (please be as specific as possible)?
97.
*

What attracted you to Providence Christian College?
98.
*

Because Providence is new, we are looking for students who wish to help us shape this institution into a God-glorifying college.  As a potential student, what gifts and talents do you possess that will help to shape student life, the envrionment, or culture at Providence?  Please be specific in your answer, explaining what types of clubs, activities, etc., in which you would be willing to play an active role?

Do you know of any other students who may be interested in attending PCC or do you have high school aged brothers and/or sisters who may be interested in Providence? 
99.

First and last name:
100.

Telephone number (555-555-5555):
101.

High School:
102.

Graduation year:
103.

First and last name #2:
104.

Telephone number:
105.

High school:
106.

Graduation year:

The Providence Perspective

Please review each of the following document prior to submitting your application.

By signing below, I certify that I have read the above statements and will conduct myself in accordance with these standards.  I further, to the best of my knowledge, declare that all the statements in this application are accurate and complete. 
107.
*

Name:
108.
*

Date (mm/dd/yyyy):
* Enter Your Email Address:
Type in the text that you see above:
  
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