Undergraduate Application

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Undergraduate Application
Office of Admissions

Other admission applications:

Graduate

International Student
Design for Leadership

First-Time College Students

Complete all parts of this application.
Request that an official copy of your high school transcript be forwarded to the Office of Admissions at 701 N. Clinton Street, Defiance, Ohio 43512. High School Transcript Request Form (click here) - print and give to your high school counselor
Request that your ACT or SAT be forwarded to the Office of Admissions, Defiance College.
Codes: ACT: 3264, SAT: 1162
The $25.00 application fee has been waived since you are applying for admission on-line. A campus visit with an admission counselor will also waive this fee.

Transfer Students

Complete all parts of this application.
Request that official copies of your high school and all college and university transcripts be forwarded to the Office of Admissions, 701 N. Clinton Street, Defiance, Ohio 43512. High School Transcript Request Form (click here) and College Transcript Request Form (click here) - print and give to your high school counselor and your college official.
The $25.00 application fee has been waived since you are applying for admission on-line. A campus visit with an admission counselor will also waive this fee.
Be in good academic and social standing at your previous college(s).Your academic and social standing at your prior school(s) may be investigated after enrolling with Defiance College.

It is your responsibility to have official transcripts from all high schools, colleges or universities that you have attended sent to the Office of Admissions.

Transient Students or Visiting Students
If you are interested in taking summer classes at Defiance College and transferring your credits back to your home college, please contact the DC Registrar's Office at 419-783-2551 or 1-800-520-4632. They will send you the proper forms for a transient student or a visiting student or you can print the form. You do not need to fill out the application form below to be a transient student. Students who are enrolled in another recognized college and wish to take a course from Defiance College are required to submit a statement of approval from the student's home college. An additional fee of $10.00 per registration includes the cost of sending a Defiance College transcript to the student's institution.

Please note when filling out this form: Use the Tab button to switch from question to question, or use your mouse. Hitting the return key will submit the form. The information you provide is encrypted for security. Secure information means the information you provide, such as your SSN, is encrypted (secure) so it can't be read or intercepted by other people.

PERSONAL INFORMATION

Defiance College admits students regardless of race, color, religion, gender, age, national and ethnic origin, disability, or sexual orientation.

First Name			Middle Name
Last Name			Preferred Name
Maiden Name

Mailing Address
City	State	Zip/Postal Code
County	Country

My Home Phone

My Email

Alternate Phone

My Cell Phone

Preferred Method of contact

Would you like to be contacted via text message?		Y		N

Date of Birth

Social Security No.

Have either of your parents attended college?

Are you a US citizen?

If no, Country of Citizenship

If no,
Are you a permanent resident?

Gender Female Male

Marital Status			Religious Preferences (Optional)

Military Service:

Are you a veteran or are you active duty military/reserve?	Y	N
If yes, Branch of Service:

Are you a dependent or spouse of a veteran or a dependent or spouse of an active duty military/reserve?	Y	N
Veteran Type:

Ethnic Origin
Are you Hispanic/Latino?	Y	N
Are you from one or more of the following racial groups:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

ACADEMIC INFORMATION

Applying for the year (ex. 2012)	Fall Semester	Spring Semester	Summer Session
Applying as:	Freshman (First-time college student)	Transfer	Non-degree Seeking
Enrollment:	Full-Time	Part-Time
Attend classes:	Day	Evening	Weekend


Have you previously attended Defiance College?
If Yes, student ID#

Housing Preference:


Major Preference:
*Choice #1*
*Choice #2*

If an education major was selected above, choose a teaching field or a licensure.

ACADEMIC HISTORY

Have you taken post-secondary classes during high school?

College Attended:

Please list all high schools, colleges, or universities you have attended, beginning with the most recent:

Date of Graduation	Name	City	State	Dates Attended	Degree



Official transcripts of all high school and college work must be submitted directly to the Office of Admissions.

Guidance Counselor Name

Guidance Counselor Phone

Guidance Counselor E-mail

Self-reported G.P.A.

Self-reported ACT composite score Essay Score

Self-reported SAT composite score

SAT critical reading math writing

Self-reported college G.P.A. (if applicable)

Are you an International Baccalaureate student?

Are you currently on academic probation or academic suspension at your previous institution?

If yes, please explain. Name of school and explanation.

Are you in good social standing at your previous college(s)
or university(ies)?

If no, please explain. Name of school and explanation.

Note: Your academic and social standing at your prior school(s) may be
investigated after enrolling with Defiance College.

SCHOLARSHIP CONSIDERATION

In which competitive scholarships/awards are you interested? Carefully read the criteria for each of the following scholarships to make sure you qualify before checking the box.

Invitations for the Scholarship Day Program will be sent following your acceptance. In order to participate in the scholarship day program, students must be accepted for admission by Saturday, November 10, 2012, Saturday, February 2, 2013 or Saturday, February 16, 2013 respectively.

SCHOLARSHIP DAY PROGRAMS

Presidential Scholar Program: $12,000 - Full Tuition

Eligibility:
High school GPA of 3.50/4.0 scale and ACT composite of 27 or SAT combined* score of 1220

Scholarship Programs on: Saturday, November 10, 2012, Saturday, February 2, 2013 or Saturday, February 16, 2013 .

Pilgrim Scholar Program: $11,000 - $16,000

Eligibility:
High school GPA of 3.20/4.0 scale and ACT composite of 24 or SAT combined* score of 1110

Scholarship Programs on: Saturday, November 10, 2012, Saturday, February 2, 2013 or Saturday, February 16, 2013.

Achievement Scholar Program: $10,000 - $13,000

Eligibility:
High school GPA of 2.80/4.0 scale and ACT composite of 21 or SAT combined* score of 990

Scholarship Programs on: Saturday, November 10, 2012, Saturday, February 2, 2013 or Saturday, February 16, 2013.

Service Leadership Award ($2,000)

New students with a demonstrated record of service in their communities are eligible. The Service Leadership Program offers Defiance College students unique and exciting programs to develop leadership skills that will strengthen their individual career interests. For application information, go to http://www.defiance.edu/service_leaders.html. Qualified applicants will be invited to campus for an interview on Saturday, November 10, 2012, Saturday, February 2, 2013 or Saturday, February 16, 2013.

ADDITIONAL SCHOLARSHIPS

Lillian Rae Dunlap Award ($1,000)

Awarded annually to students contributing to the diversity of the Defiance College campus. Minimum 2.25 high school GPA. Deadline is March 1.
More Information | Award Application

Defiance College Award ($5,000-$10,000)

Monies are awarded when accepted in good standing and are based upon review of academic performance, i.e. official high school transcripts, college transcripts, ACT/SAT scores, high school or college grade point average, and coursework.

United Church of Christ (UCC) Award (Up to $2,000)

Awarded annually to UCC member and must demonstrate financial need.

Alumni Legacy Award (Up to $4,000)

Awarded annually to a dependent of a Defiance College graduate and must demonstrate financial need.

Richard W. Stroede Scholarship ($1,000)

Awarded annually to a student interested in participating in Music Programs at Defiance College. Selection is based on on-site auditions the spring prior to the student's first fall enrollment. Richard W. Stroede Scholarship winners must enroll for a minimum of one credit hour per semester of music ensembles, and maintain a 2.0 grade point average. The Richard W. Stroede recipient must also take one credit hour of an applied lesson per semester. Awarded annually in $500/semester increments.

Music Talent Award ($500)

Awarded annually to a student interested in participating in music programs at Defiance College. Selection is based on on-site auditions the spring prior to the student's first fall enrollment. Music Talent Award winners must enroll for a minimum of one credit hour per semester of music ensembles, and maintain a 2.0 grade point average. Awarded annually in $250/semester increments.

Northwest State Community College (NSCC) Transfer Scholarship ($2,000)

Awarded annually to a student holding an associate degree from Northwest State Community College in Ohio.

Owens Community College Transfer Scholarship ($2,000)

Awarded annually to a student holding an associate degree from Owens Community College in Ohio.

Phi Theta Kappa Scholarship (Up to $10,000)

Awarded annually to a transfer student who is a member of Phi Theta Kappa.

Some awards may be combined to increase your total aid package. Contact your admissions representative for further details. For full-time undergraduate students beginning their Defiance College education in Spring 2012 or Fall 2012. Renewal based upon academic performance at Defiance College.

Need-based financial aid is separate from merit aid.

*(writing assessments are not included with the test scores)

FAMILY INFORMATION

With whom do you live?

Parents:
Married	Divorced	Separated
Mother deceased	Father deceased


Full Name:
Street Address:
City:
State:
Home Phone:
Cell Phone:
E-mail Address:
Employer:
Job Title:
Highest level of Education


Full Name:
Street Address:
City:
State:
Home Phone:
Cell Phone:
E-mail Address:
Employer:
Job Title:
Highest level of Education

Names and ages of siblings and their years of high school graduation

Names and ages of applicant's children and their years of high school graduation

Names of friends and relatives who are alumni of or are affiliated with Defiance College (specify relationship please) ie: faculty, staff, current or former student, etc.

CO-CURRICULAR ACTIVITIES

High School Activities

Please list the activities in which you participated during high school
(and in college for transfer students)

Defiance College Activities
In which activities do you plan to participate in college?
Academic Associations	The Defender (Newspaper)	Progeny (literary magazine)
American Marketing Assn.	Ecology Club	PULSE (Peers Understanding Leadership & Social Education)
BASA (Black Action Student Association)	Fraternities or Sororities	Religious Activities
CAB (Campus Activities Board)	Habitat for Humanity	SIFE (Students in Free Enterprise)
Cheerleading	Honors Program	Social Work Assn.
Club Wrestling	Instrumental Music	Student Government
Criminal Justice Society	Intramurals	Theater
Community Service/Outreach	Marching Band	Vocal/Choral Music
DC Pride	Oraculum (yearbook)	Other
	Pep Band

Intercollegiate Athletics
In which intercollegiate activities do you plan to participate?
Baseball	Basketball	Track and Field
Softball	Soccer	Football
Volleyball	Golf	Tennis
Cross-Country	Lacrosse	Swimming and Diving

GENERAL INFORMATION

Other colleges to which you are applying? (Optional)
(Please include city and state)

What influenced you the most to apply to Defiance College?

Additional Information (Optional)

1. Describe any scholastic, volunteer/service, or athletic accomplishments earned
while in high school.

2. Explain any important events that have affected your life, or explain any aspects of your academic record that you wish to clarify.

A short essay may be requested at a later date. If upon review of your application for admission, it is determined that a writing sample may further support your candidacy for admission to Defiance College, you will be notified by the Admissions Office.

3. Please provide us the name of your local newspaper so that we can provide news of you regarding scholarships, honors, extra-curricular activities, etc.

Defiance College has my permission to notify news media of my name and information related to my acceptance for admission and/or a scholarship award.	Y	N

4. Have you ever been convicted of, pled guilty, or no contest to a felony or misdemeanor charge (other than a minor traffic violation) or are charges pending against you?	Y	N

If yes, please provide an explanation:

APPLICANT STATEMENT

By submitting this application to Defiance College I certify that the information given on this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of information on this form could render me subject to immediate dismissal from the College. I am also aware that all transcripts and other documents submitted to Defiance College in support of my application become the property of Defiance College.

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