Birmingham - Homeschool Dual Enrollment Application

Which Semester are you applying for?(Required)

Student Information

Name(Required)

First Middle Last

Preferred First Name

Gender(Required)

Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Cell Phone(Required)

Student Email(Required)

Parent/Guardian Email(Required)

City / State of Birth(Required)

Date of Birth(Required)

Current Age(Required)

Please enter a number from 0 to 120.

Social Security Number(Required)

Citizenship(Required)

Ethnicity(Required)

Race(Required)

Religious Preference(Required)

Name of Church you attend?(Required)

Church Location : City / State(Required)

Family Information

Parent / Guardian Name(Required)

First Last

Relationship(Required)

Parent / Guardian Address(Required)

Same as Applicant

Street Address Address Line 2 City State ZIP Code

Parent / Guardian Phone(Required)

Would you like to add an additional Parent / Guardian contact?

Name(Required)

First Last

Relationship(Required)

Email(Required)

Address

Same as Applicant's

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Additional Information

Has anyone in your family previously and/or currently attends Faulkner University or Alabama Christian College?(Required)

Please list name and relationship.(Required)

Faulkner University would like to know more about you. List high schol activities in which you have participated. Include honors, awards, titles, or special responsibilities. Please also list any hobbies, other areas of special interest, or what you like to do in your free time.(Required)

Have you ever been in violation of criminal or civil statutes other than minor traffic viloations?(Required)

Please Explain:(Required)

Agreement

If accepted to Faulkner, I agree to abide by the moral and educational standards of Faulkner University as defined in the University catalog and student handbook. Specifically, I acknowledge that, if admitted as a student at Faulkner University, I am expected to abide by standards of conduct consistent with Biblical principles. These standards include, but may not be limited to, refraining from inappropriate dress, the use of alcohol, drugs, tobacco, and tobacco products, the use of weapons, vulgar and abusive language, inappropriate interpersonal relationships, and the use of any media that may be detrimental to my spiritual and moral development.(Required)

I agree

I certify that all information provided by me related to my admission to Faulkner University is true, complete, and accurate. I give Faulkner University my permission to verify any and all information related to my admission, including the information contained in this application. I agree to release copies of U.S. and/or state tax returns upon request. I will also notify the Financial Aid Office of any significant changes. Furthermore, I certify that I am not delinquent on any federal debt.(Required)

I certify the above statements are true.

Birmingham – Homeschool Dual Enrollment Application

Student Information

Family Information

Additional Information

Agreement