DATE RECEIVED:

START DATE:
DATE ACCEPTED:
QTR. PLACED:
APP. FEE PAID:
REPRESENTATIVE:
CHECK NUMBER:


APPLICATION FOR ENROLLMENT
There is a non-refundable application fee of $100, which must be paid at the time of application.

General Information-
Name:
(Last) (First) (Middle)
Address:
(Street) (Unit)

(City) (State) (Zip) (Country)

Social Security Number: Date of Birth:

Primary Phone: Secondary Phone:

Email:

How did you hear about The Circus?

Your Admissions Representative:

Previous Education
School name: City and State:

Dates of attendance:

Degree earned:
Associate’s Bachelor’s
Master’s Doctorate

Emergency Contact
Name:
(Last) (First) (Middle)
Relationship:

Primary Phone: Email:

Personal Information
Gender:
Male Female

Ethnic Group:
White (non-Hispanic) African American/Black Asian or Pacific Islander
Alaskan Native Hipanic Native American
 
 APPLICATION FOR ENROLLMENT Page 2

Disability Identification
Your acceptance to The Creative Circus is not in any way associated with your disability status. Notifying the Creative Circus that you
have a disability is optional and confidential. However, in order for us to evaluate our ability to meet any special needs or to provide
you with information about the services we offer, we require advance notice of any disabilities that may affect your ability to complete
the program here.

Check any that may apply:

Deaf Visual Impairment Mental Impairment
ADD/ADHD Learning Disability Physical Impairment
Addiction

Please detail your disability and the type of assistance you request below:

Have you ever been convicted or plead guilty to a crime other than a traffic violation?
Yes No
If yes, describe in full:

Areas of Interest
Select your program of choice:
Art Direction Copywriting Design
Image/Photography Interactive Development

Select your start date:

Jul 6, 2009 (Summer) Oct 5, 2009 (Fall)
Jan 4, 2010 (Winter) Apr 5, 2010 (Spring)

Will you need information on housing?

Yes No

Will you need information on Financial Aid?

Yes No

Please list other schools to which you have applied/inted to apply:

Essay
Please attach your answer to the following question on a separate sheet with you name, program and start date at the top.
Minimum 150 words.

In what ways will I participate and contribute to my own education in order to be a successful student and graduate of The
Creative Circus?