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Leadership Profile

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 : 

Emergency Contact Information:

Name:
Phone Number:

Relationship of contact person to applicant :