Central Christian College - Excel Information

Admission Application

If you are NOT a citizen of the United States or Canada, and NOT an eligible noncitizen, you must fill out the International Student Application instead.

To make a copy of this application for your records, push the "PRINT" button on your browser.

"*" designates a required field. If non-applicable, please type "NA".

Program Information
*This application is for:
If for the Ministry Certificate Program:	Degree Non-Degree
Student Information
Name
* First Name:
* Middle Name:
* Last Name:
Maiden Name:
* Preferred Name:
Home Address
* Number, Street:
* City:
* State/Province:
* Zip:
* Home Telephone:	e.g. (620)241-0723
Cell Phone:	e.g. (620)241-0723
Current Address (if different)
Address:
City:
State/Province:
Zip:
Telephone:	e.g. (620)241-0723
At Current Address until:
*Email Address:
*Are you a Kansas Resident:	Yes No
If Yes, County of Residence:

STANDARDS OF CONDUCT
Central Christian College reserves the right to dismiss a student, who, in its judgment, does not conform either to the stated regulations governing student conduct or to the expressed principles, policies and programs of the College as listed on the College website www.centralchristian.edu

I understand that withholding information on this application or giving false information will make me ineligible for admission. With this in mind, I certify that the above statements are correct and complete.
* Applicant's "Signature": (type your name; a typed name is accepted as online signature)
* Date:

*Central Christian College does not discriminate against applicants, students or employees on the basis of race, color, handicap, national origin, sex or age

(After Submitting your Application, you may press the Back button to return to this page.)