Forrest Junior College Online Application

The mission of Forrest Junior College is to provide an environment which inspires students to develop the confidence to reach their unique potentials through educational experiences that encourage respect for individual differences and emphasize life-long learning

Personal Information

Last Name:    First Name:    Middle:    Maiden:      Preferred:

Date of Birth:    Social Security Number:   

Mailing Address:    City:    State:    Zip:   

Home Phone:    Street Address (If different):   

City:    State:    Zip:    Personal E-mail:   

Mobile Phone:    What is your state of Legal Residence:    Driver's License Number:

Check all that apply:

Current Employer:    Address:    Phone:   

Fax:    Work E-mail:    Position:

Intended Course of Study

Associate in Applied Science Degree/Business      Associate in Applied Science Degree/Medical Assisting
Associate in Applied Science Degree/Criminal Justice

Discuss your reasons for choosing this course of study and your career goals:

Educational Information

High School:    State:    Graduated? Yes      No     GED

Date of Graduation/GED (mm/yyyy):

Have you attended any other colleges:   Yes        No

College Attended:          State:      Dates Attended (mm/yyyy):    to:

Have you ever been dismissed or suspended from an educational institution for academic or disciplinary reasons?

Yes         No

Emergency Information

Emergency Contact:    Relationship:

Address:    City:    State:    Zip:

Home Phone:    Work Phone:

Childcare is available free of charge to students while they attend classes

Will you need childcare?       Yes        No

If you chose "Yes" above, list your child(ren)s' name and age below

Child's Name:             Age:
Child's Name:             Age:
Child's Name:             Age:
Child's Name:             Age:

Do you own a computer? Yes       No

If you chose "Yes" above, what type of computer do you own?

What software programs are installed? (choose all that apply)

If you answered "No" above, would you be interested in renting or purchasing a computer while at College?
    Yes        No

I understand that the use of illegal drugs or alcohol is prohibited on College property.               

Forrest Junior College accepts qualified applicants regardless of race, religion, sex,
age, handicap, sexual orientation, or ethnic group.  I give Forrest Junior College
permission to use my photograph and/or likeness at no charge or fee for advertising
purposes to the school and it's programs.                                                                                        

I have received a copy of the Forrest Junior College catalogue and understand that I am
responsible for its contents.  Additionally, I am aware that the full catalogue is available
on the College's Web site (www.forrestcollege.edu).                                                                      

More and more companies today are requiring an absence of criminal history in an applicant's background.  Therefore, please be advised that as a student you should be aware that you may be subjected to a criminal background check when applying for a position in your chosen field of study and that having a criminal history may preclude any chance of actually acquiring a job in your field (or sitting for certain certification exams).  The College is not responsible for any ineligibility on your part to be qualified for a job based on your previous criminal history.

I understand that any evidence of criminal activity in my background will make me ineligible    
for certain jobs or certifications.

By entering my name below I acknowledge that I have read and understand the previous statements.  (Note:  failure to supply complete and accurate information may result in termination of application or enrollment)

                              Name:                               Date: (mm/dd/yyyy)