Full Legal Name (required)

Permanent Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone Number

Mobile Phone Number

Work Phone Number

Email (required)

Parent/Guardian Name(s)

Parent/Guardian Address

Parent/Guardian Email Address

Parent/Guardian Primary Phone Number

As prescribed by the Department of Education and the National Center for Education Statistics, we are required to ask for demographic information including racial background. This information is not used in the admission process. Using the terminology of the NCES, please answer each of the following:

Select Race/Ethnicity:
Please SelectHispanic or LatinoAmerican Indian or Alaskan NativeAsianAfrican AmericanHawaiian or Pacific IslanderWhite or Caucasian

Are you a U.S. Citizen?
YesNo

If no, are you a..
Please SelectPermanent ResidentResident AlienNon-resident Alien

Gender
Please SelectMaleFemale

Date of Birth

Place of Birth

High School:

High School GPA:

Class Rank:

High School Address:

When will (or did) you graduate?

High School Type
Please SelectPublicPrivatePrivate Cristian High SchoolHome School

By submitting this application online, you have initiated the John Witherspoon
College admissions process. Additional materials as noted in the CHECKLIST BELOW are
required to complete your application file.

CHECKLIST: The following will be needed to complete your application file:
□ HIGH SCHOOL TRANSCRIPT

Please sign your name below to you authorize that the above information is accurate to submit for your online application to John Witherspoon College.

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