Early College for High School Students

Application for Admission

First Name:
Last Name:
Address:
City:
State:
County:
Zip Code:
Date of Birth:
Social Security Number:
Gender:	Male  Female
Telephone:
Telephone (cell):
Email address:
High School:
High School Graduation Year:
Current GPA:
Current Grade Level:	Junior  Senior
Name of guidance counselor submitting approval:
How did you first hear about Cedar Crest College?
I am registering for Courses for the :	Fall 2012 Spring 2013 Summer 2013 Fall 2013 Spring 2014 Summer 2014
Emergency Contact Information:
Name:
Phone Number:
Relationship of contact person to applicant :