Personal Information
First Name*:
Middle Name:
Last Name*:
Preferred Name:
Street Address*:
City*:
State*:
NA - Not Applicable
AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
ME - Maine
MD - Maryland
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Zip*:
Telephone*:
e.g.
(620)241-0723
Alternate Phone:
Email:
Year of Entry:
Fall
Semester - August
Interterm
Semester - January
Spring
Semester - February
Country of Citizenship:
United States
Canada
Other:
Eligible
noncitizen
Alien Registration Number:
I am interested in the following Academic Majors:
I am interested in the following
Collegiate Sports as my primary
sport :
None
Baseball
(men)
Basketball
(men)
Basketball
(women)
Cheerleading
(men)
Cheerleading
(women)
Golf
(men)
Golf
(women)
Soccer
(men)
Soccer
(women)
Softball
(women)
Tennis
(men)
Tennis
(women)
Volleyball
(women)
I wish to also participate in these collegiate sports at
Central:
None
Baseball
(men)
Basketball
(men)
Basketball
(women)
Cheerleading
(men)
Cheerleading
(women)
Golf (men)
Golf (women)
Soccer
(men)
Soccer
(women)
Softball
(women)
Tennis (men)
Tennis
(women)
Volleyball
(women)
Please send me:
Poster
Application
(Go to our Online Application )
Other:
I heard about Central Christian College from:
<Please select an option>
Advertisement- Campus Life
Advertisement- Central Poster
Advertisement- FCA
Advertisement- Radio
Advertisement- Other – Name:
Internet search -- Ask Jeeves
Internet search -- Google
Internet search -- InfoSeek
Internet search -- Iwon
Internet search -- LookSmart
Internet search -- Lycos
Internet search -- MSN
Internet search -- Netscape
Internet search -- Overture
Internet search -- RedZee
Internet search -- Yahoo
Internet search -- Other:
Mail (Electronic) - from Central – Month/Year:
Mail (U.S.) - Card Deck - Campus Life
Mail (U.S.) - Card Deck - College Choice
Mail (U.S.) - Card Deck - Homeschool
Mail (U.S.) - Central Coach – Name:
Mail (U.S.) - Central Faculty member – Name:
Mail (U.S.) - Other:
Person- Central Alumnus – Name:
Person- Central Current Student – Name:
Person- Central Employee – Name:
Person- Friend – Name:
Person- High school coach – Name:
Person- High school counselor – Name:
Person- High school employee (other) – Name:
Person- Pastor (Free Methodist) – Name:
Person- Pastor – Name:
Person- Parents – Name:
Person- Sibling – Name:
Person- Other:
Place- College Fair – Name:
Place- College performing group – Name:
Place- Church – Name:
Place- Other:
Reference- Peterson’s Guide
Reference- Other College Guide – Name:
Reference- Other:
Other:
If you used an internet search engine to find CCC's website,
which key words did you use in your search?
Verify the Text: