| Personal
Information |
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First Name:
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| Last Name: |
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| Middle
Name: |
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| Gender:
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Male
Female |
| Address: |
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| City: |
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| State: |
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| Zip
Code: |
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| Home
Phone: |
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| Cell
Phone: |
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| Date of
Birth: |
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| E-mail
Address: |
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Tribal
Affiliation: (Enrollment) |
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| Ethnic
Origin: |
White (non-Hispanic) |
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Black (non-Hispanic) |
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Hispanic |
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Asian or Pacific Islander |
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American Indian / Alaska
Native If
American Indian, specify
tribe(s):
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Other
(specify)
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| Marital
Status: |
Married |
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Widowed |
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Single |
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Separated |
| If married,
have you or your spouse been divorced?
(see Admissions Policy Manual) |
Yes
No |
If yes, please
briefly explain below: |
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| Name of
spouse:: |
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Names and ages
of your dependent children (one
per line, please): |
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| How did you
first hear about American Indian
College? |
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| Are you a
veteran? |
Yes
No |
Are you
eligible for VA benefits? |
Yes
No |
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information of parent or nearest
relative (other than spouse) that AIC may notify in case of
emergency: |
| First Name:
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| Last Name:
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| Middle
Name: |
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| Home
Phone: |
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| Cell
Phone: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Application Information |
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Application for: |
Fall 20
Spring 20
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Admission Status: |
Freshman
Transfer |
| I
plan to attend AIC: |
Full-time
Part-time |
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Are you seeking a degree from AIC? |
Yes
No |
| Which degree are
you interested in earning? |
Bachelor of Arts in Elementary Ed
Associate of Arts in
Business
Bachelor of Arts in
Christian Ministry
Associate of Arts in Christian Ministry |
Area of academic interest:
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Church Ministries
Christian
Education and Youth Ministry
Intercultural Ministries
Bible |
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What is your career goal? |
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Please list 3 reasons
why you chose to apply to American Indian College: |
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1.
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2.
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3.
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What other colleges or
universities are you considering applying to?
(Please list these institutions in the order of preference and
include AIC): |
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1. |
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2. |
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3. |
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4. |
| Do
you wish to be considered for Financial Aid? |
Yes
No |
If
you wish to be considered for financial aid, please submit a
Free Application for Federal Student Aid
(FAFSA).
http://www.fafsa.ed.gov |
| I
have/will submit a FAFSA on (Date): |
//20 |
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Have you applied for a tribal scholarship? |
Yes
No |
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Educational
Background |
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High School Diploma
GED
College/University |
| High School
Name: |
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| City: |
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| State: |
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| Date
Graduated: |
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| Date GED
Passed: |
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Other Schools
and Colleges or Universities attended: |
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Scholastic
Honors/Awards:
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Church
Information |
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Church Name: |
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Church Phone: |
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Address: |
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City: |
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State: |
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Zip: |
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Denomination: |
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Christian
Experience |
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How long have you
been a Christian? |
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Please give a
brief account of how you became a born-again Christian: |
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Do you feel the
call to some Christian ministry or service? Please explain: |
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Church/Pastor
Information |
| Name: |
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| Phone: |
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Title/Position: |
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| Church Name: |
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| Address: |
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| City: |
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| State: |
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| Zip Code:
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Employment
& Experience Information |
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Non-church related: |
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Church related
(include all paid and volunteer positions, committees, services and
activities during the past five years): |
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Special
Consideration |
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Have you ever been
dismissed from school or placed on academic or disciplinary
probation? |
Yes
No |
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Do you have any
physical handicaps which might require special consideration from
the college? |
Yes
No |
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Have you ever used
tobacco, alcohol or illegal drugs? |
Yes
No |
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Have you ever
received professional care for emotional problems?
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Yes
No |
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Have you ever been
convicted of a crime?
see"Admissions Policy Manual" |
Yes
No |
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Have you ever been in
jail?
"Admissions Policy Manual" |
Yes
No |
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If you checked
"yes" to any of the above, please explain below, including dates.
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Personal
Statement |
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Statement: My initials
below affirm that I am in agreement with the mission and purposes of
the American Indian College of the Assemblies of God. I certify that
the answers in this application are correct to the best of my
knowledge and belief. I understand that any failure to fully
disclose all required information may void my application. I further
understand that any subsequent determination of dishonesty in the
application will be grounds for dismissal from the college.
Date:
Initials:
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