Inquiry Form : Defiance College

We would love the opportunity to show you how we will defi the ordinary together!

Note that this form is the complete application to Defiance College.

Email *

Enter the same email address if you have previously inquired.

First Name *

Middle Name

If No Middle Name, enter N/A.

Last Name *

Preferred First Name

Suffix

Date of Birth *

Primary Phone *

Primary Phone Country Code

I'd like to receive text and voice messages to this number and I have read the opt-in policy.

Social Security Number *

Marital Status *

Divorced Married/Remarried Single Widowed

Gender/Sex *

Religious Affiliation

Student Type *

Please select "Freshman" if you are a high school student enrolling in college for the first time.

Test-optional *

Have you taken the ACT/SAT? If you have not, select "Yes" for applying test-optional.

Are you here on a visa? *

Yes No

What type of visa is it? *

Citizenship Status *

Country of Citizenship *

Ethnicity *

Race *

First Generation *

First-generation college students are defined as students whose parents have not yet attained an associate or bachelor's degree.

Entry Year *

Let us know the year you will enter college.

United States Veteran? *

Yes No

For what branch of the military are you a veteran? *

Are you receiving veteran's benefits? *

Yes No

Are you currently on active US military duty? *

Yes No

For what branch of the military are you currently on active duty? *

Dependent of a Veteran? *

Yes No

Address Line 1 *

Address Line 2

City *

State *

Zip/Postal Code *

If you do not have a postal code please type in 00000.

County *

Enter County Name only, for example, Defiance, not Defiance County.

Country *

Secondary Phone

Secondary Phone Country Code

Entry Term *

See Entry Year in the Personal Information section above.

Full-Time or Part-Time *

Part Time Full Time

Housing Type *

Major *

Minors

High School *

Additional Names on Transcripts *

High School Attended *

High School GPA *

Do you have a GED? *

Yes No

High School Graduation Year *

Please list your Guidance Counselor Name, Phone, and E-mail address. *

High School Transcript

If you have your transcript, please upload it here. If you do not have it ready, you can skip it now and submit your transcript to us later.

Have you previously applied to our school? *

Yes No

What year did you apply to our school? *

How many Colleges/Universities have you previously attended? *

1st College/University Attended *

College 1 *

College 1 Transcript

Student T-Shirt Size *

In what country is the college that you attended? *

Beginning Attendance Date of Most Recent Attended College/University *

End Date of Most Recent Attended College/University *

College 2 *

College 2 Transcript

2nd College/University Attended *

2nd Attended College/University City *

In what country is the 2nd college that you attended? *

Beginning Attendance Date of Other College/University *

Ending Attendance Date of Other Attended College/University *

Please list the additional Colleges/Universities that you've attended *

College 3 Transcript

No file chosen If you have transcripts from more than 3 colleges, please contact us to submit all additional ones.

Are you on academic/social probation at any other college? *

Yes No

Please explain the circumstances around your probation at the other school *

Parent/Guardian's 1 First Name

Parent/Guardian's 1 Last Name

Who is this person in relation to you?

Parent/Guardian's 1 Email Address

Parent/Guardian's 1 Address Line 1

Parent/Guardian's 1 Address Line 2

Parent/Guardian's 1 City

Parent/Guardian's 1 State

Parent/Guardian's 1 Zip/Postal Code

Parent/Guardian's 1 Mobile Phone

Parent/Guardian's 2 First Name

Parent/Guardian's 2 Last Name

This person is your?

Parent/Guardian's 2 Email Address

Parent/Guardian's 2 Address Line 1

Parent/Guardian's 2 Address Line 2

Parent/Guardian's 2 City

Parent/Guardian's 2 State

Parent/Guardian's 2 Zip/Postal Code

Parent/Guardian's 2 Mobile Phone

Primary Activity *

Secondary Activity

Are you currently recruited by a coach or band/choir director? *

Which coach/director are you working with? *

Have you ever been convicted of, pled guilty, or no contest to a felony or misdemeanor charge (other than a minor traffic violation), had a juvenile adjudication, or are charges pending against you? *

Yes No

If yes, please provide an explanation *

What are your educational and career goals and how do you feel Defiance College will help you reach them? *

List other colleges to which you are applying: *

What influenced you the most to apply to Defiance College? *

Occasionally, candidates for admission will make inaccurate or misleading statements or submit false material in connection with their application. In most cases, these misrepresentations are discovered during the admission process, and the application is rejected. If a misrepresentation is discovered after a candidate is admitted, the offer of admission is withdrawn. If a misrepresentation is discovered after a student has registered, the offer of admission will be revoked, and the student will be required to leave the School. If the discovery occurs after a degree has been awarded, the degree will be rescinded. The determination that an application is inaccurate or contains misrepresentations rests with the Office of Admissions, which has the authority to resolve the matter outside the student disciplinary process.

Please enter your full name: *

Today's Date *

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Defiance College Application Form

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