| APPLICANT INFORMATION |
| *Name |
|
| Nick name (if preferred) |
|
| *Address |
|
| *City |
|
| *State |
|
| *Zip/Postal Code |
|
| County |
|
| *Phone |
|
| E-mail |
|
| Date of Birth |
|
| Social Security Number |
|
| High School |
|
| Present Grade |
|
| Current Grade Point Average (GPA) |
|
| Name of Hometown Newspaper |
|
| City of Hometown Newspaper |
|
| *Which campus will you be attending? |
Angola Main
Angola North Branch
Fort Wayne Branch
South Bend Branch
Merrillville Branch
|
| *Which semester are you applying for? |
|
| Race/ethnic background(optional) |
|
| Are you a 21st Century Scholar? |
Yes
No
|
| ACADEMIC PLANS |
How many courses are you interested
in taking your first semester |
|
| What class options are you considering? |
|
PARENTS' INFORMATION |
| Father's Name |
|
| Father's level of education |
below HS level
HS diploma
1-2 years college
college diploma
Masters
beyond Masters
|
| Father's Address |
|
| City |
|
| State |
|
| ZIP |
|
| Father's employer |
|
| Father's work phone number |
|
| Mother's Name |
|
| Mother's level of education |
below HS level
HS diploma
1-2 years college
college diploma
Masters
beyond Masters
|
| Mother's Address |
|
| City |
|
| State |
|
| ZIP |
|
| Mother's employer |
|
| Mother's work phone number |
|
| Have any of your grandparents ever attended college? |
Yes
No
|
How did you hear about the
Middle College opportunity? |
guidance counselor
friends
letter
website
other
|
| If other, please explain: |
|
| Are you presently enrolled in any other concurrent/dual credit classes,
for example AP classes? |
Yes
No
|
| If yes, where? |
|
| Number of credits |
|
| Level of family income: |
below $25,000
$25,000-$50,000
$50,000-$75,000
$75,000-$100,000
over $100,000
|
