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Application for Undergraduate Admission

*Please use Mozilla Firefox or Google Chrome to complete the forms below.

Personal Information

Your Full Legal Name:

 

Last

Maiden

First

Middle

Preferred Name

Home Address:

 

Number and Street

 

City

State

Zip Code

Country (If not USA)

Preferred Phone Number:
(Please select a phone number type)


Secondary Phone Number:
(Please select a phone number type)


Email Address:

Preferred Method of Contact:

Current Mailing Address
(if different from above):

 

Number and Street

City

State

Zip Code

Date Address is No Longer Active

Marital Status:

Are you a U.S. Citizen?

Please list your country of citizenship:

First Language:
(if other than English)

Language Spoken at Home:
(if other than English)

Country of Birth:

Date of Birth:

(mm/dd/yy)

Religious Preference (optional):

Gender:

Select one or more races from the following groups. (optional)
                                                       

Are you of Hispanic or Latino Origin
Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race (optional)

YesNo


Enrollment Information

What major are you interested in studying?
(If you're not sure, you can put 'Open')

Other:

Are you applying for admission to the pre-physical therapy program?

Yes
If yes, please select an undergraduate major for the Major field above.

Enrolling As:

  If returning to Clarke, years attended Clarke:

Enrollment Term:

Intended Residence:

 

(Students under age 22 must live with family or on campus.)

Intended Credit Load:


Referral Information

If someone referred you to Clarke University, provide their information.

Name:

Relationship to the Applicant:

Relationship to the University:
If an alum, please provide years of attendance.



Alum Years of Attendance:

Family Information

Please select the primary person to whom you would like parent/guardian information to be sent.

Last Name

First Name

Mailing Address:
(if different from yours)

 

Number and Street

 

City

State

Zip Code

Cell Phone:

Email Address:

Employer:

Position:

Highest Degree Earned:

If other, please specify:

Are you his/her first child to go to college?

YesNo

Please select the secondary person to whom you would like parent/guardian information to be sent.

Last Name

First Name

Mailing Address:
(if different from yours)

 

Number and Street

 

City

State

Zip Code

Cell Phone:

Email Address:

Employer:

Position:

Highest Degree Earned:

If other, please specify:

Are you his/her first child to go to college?

YesNo


Brothers and Sisters (still in school):

 

1- Full Name

Age

School Attending

HS Graduation Year

Gender

2- Full Name

Age

School Attending

HS Graduation Year

Gender

3- Full Name

Age

School Attending

HS Graduation Year

Gender


Relatives who are attending, have attended, or are currently employed at Clarke University:

1- Full Name

Relationship to You

Year(s) Attended /
Employed - Department

2- Full Name

Relationship to You

Year(s) Attended /
Employed - Department


High School Information

List the most recent high school attended and include date of graduation or anticipated date of graduation. If you have received your GED in lieu of graduation, please type GED for Name of High School.

Name of High School

City

State

Graduation/GED Date

What is the estimated size of your high school?


What is your estimated cumulative high school grade point average:

on a scale

Have you ever been placed on probation or dismissed by any high school you have attended?

If yes, please explain the circumstances below.

 

Standardized Test Information
Please list your highest composite ACT or SAT:      
Are you planning to take / retake the ACT or SAT in the future?    
If yes, list the date (month-year): 
   
Athletics
If you have competitively participated in an athletic team and wish to continue at the collegiate level, please indicate the athletic team here: (Interested in intramurals? Please skip this question and see Interests section).

Men's Athletic Teams

  Women's Athletic Teams




What position (or event) is your specialty for the indicated athletic team? 
How many years have you started at the varsity level in the indicated athletic team. 
Interests 
Please check collegiate activities in which you are interested in participating.
                                 

Other:

Transfer Information

Beginning with the most recent, list all of the colleges and universities you have attended since high school whether or not you completed the coursework or earned any credit.

1- Name of Institution

City

State

Dates of Attendance

Degree Earned

2- Name of Institution

City

State

Dates of Attendance

Degree Earned


If you have attended more than two institutions, please list the remaining schools here.

 

What is your estimated collegiate cumulative grade point average?

on ascale


If you are a memeber of Phi Theta Kappa (community college academic honor society), please check here.

Are you eligible for re-admission to the last college you attended?

If no, please explain the circumstances below.

 

Other Information

How did you first learn about Clarke University?

To which other colleges will you apply for admission?

 

List the primary influences that led you to apply to Clarke University:

 

By typing my name below, I certify that the information I am submitting in this online application is accurate to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any schools or colleges I have previously attended or am currently attending to release my personal and academic information to Clarke University and/or its representatives. Further, I agree that my college grades may be used for statistical studies or sent to my high school or community colleges for evaluation purposes. I understand that official high school (or college) academic transcripts and the results of my ACT/SAT examination must be received by Clarke University before a final admission decision can be made. My signature also gives Clarke University permission to use photos of me in any promotional materials, print or electronic.

Your Name:Date:


 

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