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Personal Information

First Name*:	Last Name*:	Middle In:
Street Address*:	City*:	State*:
ZIP/Postal Code*:	Country:	E-mail*:
Date of Birth*:	Telephone*:
Sex*:

Are you a citizen of the United States?*:

YesNoPermanent Resident

If you are not a U.S. Citizen-Country of Birth:

I am applying as*:

Freshman
Transfer

Academic Areas of Study

Associate Degrees:

Certificates:

Education Information

Freshman:

Please list every high school you have attended.

Transfers:

Please also note the college in which you are currently enrolled and all others attended.

Name of High School or College	State	Dates of Attendance Month and Year	Expected date of graduation




	x
Counselor's Name:	Counselor's Telephone #:	GPA:

SAT I Scores: Math		List Dates:
Critical Reading		List Dates:
Writing		List Dates:
ACT Scores Comp.		List Dates:
TOEFL/ELPT Scores:		List Dates:

Honors Activities

Please list any co-curricular activities in the past four years. Include specific events and/or major accomplishments, such
as musical instruments played, varsity letters, honors, awards, and prizes you have received.

Activity

Number of years
of participation

Positions held or
honors won

Continued in college?

YesNo

Full- and part-time jobs held

Employer	City/Telephone	Type of Work	Start/End date of Employment	Hours/Week

Signature of Applicant
By electronically transferring this document to Salter College, I certify the above information is complete and correct. I further understand that falsification or failure to supply the correct information may lead to the disqualification of my application for admission to Salter College. I also agree to accept full responsibility for all debts incurred.

I authorize all secondary schools and colleges I have attended to release all requested records and authorize review of my application for the admission process indicated on this form.

Salter College admits students of any race, color, national or ethnic origin, physical limitation, religion, age or sexual orientation to all rights, privileges, programs, and activities generally accorded or made available to students at the college. Salter College does not discriminate on the basis of race, color, national or ethnic origin, physical limitation, religion, age or sexual orientation in the administration of its educational policies, admission policies, scholarship and loan programs, and other College-administered programs. The information requested on the application form is for the completion of statistical information only and is not used as a basis for admission.

Thank you for applying to Salter College.