STUDENT 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

Address
City		State		Zip/Postal Code
County		Country
Gender	Female Male

STUDENT telephone:
STUDENT email:
High School name:
H.S. Address:

If known...
GPA:			ACT/SAT:
Graduation Year:

ALUMNI REFERRAL INFORMATION

Please include your name and address.

Alum Name:
Alum Address:
Alum Email:

AREAS OF INTEREST

The STUDENT would be interested in coursework offered through the following programs:
Full-time Student	Graduate Studies Weekend College

Intended College Major(s): If known, please select the major(s) that the STUDENT would be interested in. If you are unsure, please indicate "Undecided" as the first preference.
Choice #1	Undecided at this point Other Accounting Arts and Humanities Athletic Training Education Program Biology Business Administration Business Administration with a Marketing Concentration Communication Studies Criminal Justice Digital Forensic Science Education English Exercise Science Forensic Science Global Studies Graphic Design History Mathematics Ministry Studies Molecular Biology Nursing (1+2+1) Nursing (RN to BSN completion) Psychology Religious Studies Restoration Ecology Self-Designed Major Social Work Sport Management Pre-Dentistry Pre-Law Pre-Medicine Pre-Seminary Pre-Veterinary Science
Choice #2	Undecided at this point Other Accounting Arts and Humanities Athletic Training Education Program Biology Business Administration Business Administration with a Marketing Concentration Communication Studies Criminal Justice Digital Forensic Science Education English Exercise Science Forensic Science Global Studies Graphic Design History Mathematics Ministry Studies Molecular Biology Nursing (1+2+1) Nursing (RN to BSN completion) Psychology Religious Studies Restoration Ecology Self-Designed Major Social Work Sport Management Pre-Dentistry Pre-Law Pre-Medicine Pre-Seminary Pre-Veterinary Science

Collegiate Activities
If known, which activities would the STUDENT plan to participate in college?
American Marketing Assn.	Yearbook	Black Action Student Assn.
Religious Activities	Ecology Club	Criminal Justice Society
Community Service	Student Senate	Campus Activities Board
Fraternities or Sororities	Newspaper	Student in Free Enterprise
Psychological Assn.		Social Work Assn.

Intercollegiate Activities
If known, which intercollegiate activities would the STUDENT plan to participate?
Baseball	Golf	Softball
Basketball	Tennis	Swimming and Diving
Cross-Country	Track & Field	Volleyball
Football	Soccer

TELL US MORE ABOUT THE STUDENT (optional)

SEND ME SCHOLARSHIP INFORMATION

Yes No Please send information about financial aid and family financial planning.