APPLICATION FOR ADMISSION MEDICAL HISTORY
How would you describe your health? EXCELLENT GOOD FAIR POOR List any allergies you have:_ ____________________________________________________________ List any physical limitations:____________________________________________________________ List any medications you are currently using:______________________________________________ List any other physical problems or ailments:______________________________________________ _____________________________________________________________________________________
PERSONAL HABITS
Have you ever used illegal drugs? YES NO If yes, last date of use:_________________ Have you used tobacco in any form? YES NO If yes, last date of use:_________________ YES NO If yes, last date of use:_________________ Have you used alcoholic beverages? Have you ever been involved in satanic worship or other occult practices? YES NO If yes, last date practiced:__________________________________________________ YES NO Have you ever been charged with or convicted of any felony? If yes, please explain:__________________________________________________ IMPORTANT: If you answered “yes” to any of these situations, please explain briefly on a separate piece of paper the situation and how it is no longer a part of your life.
FINANCIAL HISTORY
How do you plan to pay for your tuition?__________________________________________________ Will you have the total amount by the first day of Master’s Media? YES NO If no, please explain____________________________________________________________________ Do you own your own vehicle? YES NO Do you have health insurance (required upon acceptance)? YES NO List any debts, loans, and payments that you presently have, including the amount due for each: _____________________________________________________________________________________ _____________________________________________________________________________________ Will your debts be paid off by the start of Master’s Media? YES NO If no, how will you make payments?__________________________________________________
QUESTIONNAIRE Please answer the following questions to the best of your knowledge.
1. What do you expect to gain from your experience at Morningside Master’s Media?__________
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 2. What do you plan to do after Morningside Master’s Media?_____________________________
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________