APPLICANT INFORMATION: Applicant information such as contact, personal and admissions information.

Legal Name
Last
First

Middle
Maiden (if married)



Permanent Mailing Address
Street Address
PO Box

City
State / Province

Postal Code



Contact Information
Cell Phone Area Code
Phone Number
 (while attending Jacksonville college)

Home Phone Area Code
Phone Number

Email Address



Personal Information FORMAT: xxxxxxxxx [no dashes]
Social Security/Government ID
Date of Birth
 
(mm/dd/yyyy)

Country of citizenship
Residence Country



Admissions Information
Term to begin study

Degree Code
 Degree Code 

Housing Plan...


Note: Jacksonville College requires single students under 21 years of age, not living with parents or guardian, to live in the residence halls unless an equitable agreement is made between the student and college administration.
I plan to take classes...
 Enter how you plan to take classes 


    required and     optional