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EDWARD WATERS COLLEGE APPLICATION FOR UNDERGRADUATE ADMISSION Please print in ink or type your responses. Answer all questions. Use N/A if a question is not applicable to you. Attach the nonrefundable $25 application fee to the application. Mail to: Admissions Office, Edward Waters College, 1658 Kings Road, Jacksonville, FL 32209, Phone (904) 470-8200; toll-free 1-888-898-3191 (904) 470-8048:


Social Security #______________________________________ Name_________________________________________________________________________________________ Last



Current mailing address: _________________________________________________________________________ Street Address/P.O. Box



Zip Code

Permanent mailing address: ______________________________________________________________________ Street Address/P.O. Box



Zip Code

Date of Birth: ______________Gender: _______E-mail address: _________________________________________ MM/DD/YY


Home Phone: ________________________________ Mobile Phone: _____________________________________ County in which you reside in: _____________________ Place of birth: ___________________________________ City/State/Country

Resident of Florida: _____Yes _____No

Number of years in Florida____________

Ethnic and citizenship information is requested by the Office of Civil Rights. Please check the appropriate category. ______U.S Citizen _______ Non-Resident Alien ______Resident Alien If citizenship is other than U.S., indicate country: _____________________________ Ethnic Background (for reporting purposes only) ______African- American ______American Indian or Alaskan Native ______Hispanic ______White ______Other (reserved for non- U.S Citizens) _______Asian/ Pacific Island Are you a first- generation college student?


________ No

Applying for admission as: _____Freshman ______Transfer ______Transient ______Readmit I am applying as a: ______ On-campus student _______Commuting student

Are you a Veteran? _______ If yes, do you plan to utilize your Veteran’s Benefits? ___________ Have you previously applied or been enrolled at Edward Waters College?__________________________________ If yes, what semester(s) and year(s)? ____________________________ Do you plan to earn a degree? ___Yes ___No Proposed major__________________________________________ High School attended_______________________________________City_______________________ State_____ Phone: ________________________ High School College Board code number (May be obtained from high school counselor) ______________________ Graduation Month _______________________Year_____________________ GPA________________________ Please List any university, college, technical institute, junior/ community college that you have attended: _____________________________________________________________________________________________ Institution City/State Date Attended Degree _____________________________________________________________________________________________ Institution City/State Date Attended Degree _____________________________________________________________________________________________ Institution City/State Date Attended Degree

Emergency Contact Person: _______________________________________________________________________ Relationship (Spouse, Parent, Guardian, Sibling, etc.): __________________________________________________ Home Phone: _________________________________ Mobile Phone: ____________________________________ Street Address: _________________________________________________________________________________ Street Address/P.O. Box City State Zip Code

Mother’s Name: ________________________________________________________________________________ Last First MI Telephone Number: ___________________________________ Home

_______________________________________ Mobile

Father’s Name: ________________________________________________________________________________ Last First MI Telephone Number: ___________________________________ Home

_______________________________________ Mobile

Please check area(s) of interest: ______Choir ______Band_______ Baseball_______ Basketball______ Cheerleading ______ Cross Country ______Football _______Golf ______Stunt Masters ______Track & Field ______Volleyball _______Softball

Legal Questions, Authorizations and Signature Have you ever been convicted of or charged with a criminal offense (other than a minor traffic violation)? ___Yes ___No Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere, or an Alford plea to a criminal charge?

___Yes ___No

Have you otherwise accepted responsibility for the commission of a crime?

___Yes ___No

Have you ever been suspended or expelled from a secondary school system or an institution of higher education for misconduct?

___Yes ___No

If your answer is “yes” to any of the questions above, please submit a full statement of relevant facts on a separate sheet and attach it to this form. Your signature on this application authorizes Edward Waters College to inquire about any matters referenced above, and authorizes those contacted to release information. If your answer to either question changes to “yes” after submitting this application you must notify Edward Waters College immediately. Indicating “yes” to any of the legal questions above does not necessarily disqualify you from admission to Edward Waters College, each case is reviewed on an individual bases. If it is discovered at anytime, before or after admission to Edward Waters College, that you failed to be forthcoming and honest in your answers; this will place you in jeopardy of a denial of admission or revoking of admission. Edward Waters College reserves the right to exercise any of these options at anytime during the admissions process or during your matriculation at the College. Edward Waters College also reserves the right to request/obtain a criminal background check at anytime on any prospective or enrolled students. If requested, the background check would be at the student’s expense. My signature on this application signifies that the information contained in my application is factually correct and honestly presented, and I understand that to make false or fraudulent statements with-in this application may result in disciplinary action, denial of admission and/or an invalidation of credits or degrees earned. If admitted, I hereby agree to abide by the policies, rules and regulations of Edward Waters College. I understand that once I sign and submit my application it becomes the property of Edward Waters College, and I agree to relinquish ownership and waive my right to view it. Should any information that I have given change prior to my enrollment, I shall immediately notify the Edward Waters College Office of Admissions.

Signature: _________________________________________________________ Date: ______________________ Parent/Guardian Signature (if under 18 years of age):________________________________ Date___________ Edward Waters College admits students without regard to race, color, creed, sex, religion, sexual orientation, handicap and national or ethnic origin.

Essay Please write a brief essay about the person, place or event that has had the greatest influence on your life; and what influence you expect Edward Waters College to have on your future goals. This essay should be a minimum of at least 300 words.

Term & Year of Proposed Enrollment _____Fall (August)

Year 20____

_____Spring (January)

Year 20____