Personal Information
First Name:
Middle Name:
Last Name:
Preferred Name:
Street Address:
City:
State:
NA - Not Applicable
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SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Zip:
Telephone:
Alternate Phone:
Email:
Year of Entry:
Country of Citizenship:
I am interested in the following Academic Majors:
I am interested in the following
Collegiate Sports as my primary
sport :
I wish to also participate in these collegiate sports at
Central:
Please send me:
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?
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