EDWARD WATERS COLLEGE

APPLICATION FOR UNDERGRADUATE ADMISSION

Please print in ink or type your responses. Answer all questions. Use N/A if a question is not applicable to you. Attach the nonrefundable $25 application fee to the application. Mail to: Admissions Office, Edward Waters College, 1658 Kings Road,
Jacksonville, FL 32209, Phone (904) 470-8200; toll-free 1-888-898-3191 (904) 470-8048: admissions@ewc.edu.

________________________________________________________________________________________________________

Social Security #______________________________________

Name_________________________________________________________________________________________
Last

First

Middle

Current mailing address: _________________________________________________________________________

Street Address/P.O. Box

City

State

Zip Code

Permanent mailing address: ______________________________________________________________________

Street Address/P.O. Box

City

State

Zip Code

Date of Birth: ______________Gender: _______E-mail address: _________________________________________

MM/DD/YY

M/F

Home Phone: ________________________________ Mobile Phone: _____________________________________

County in which you reside in: _____________________ Place of birth: ___________________________________
City/State/Country

Resident of Florida: _____Yes _____No

Number of years in Florida____________

Ethnic and citizenship information is requested by the Office of Civil Rights. Please check the appropriate category.
______U.S Citizen _______ Non-Resident Alien ______Resident Alien
If citizenship is other than U.S., indicate country: _____________________________
Ethnic Background (for reporting purposes only)
______African- American ______American Indian or Alaskan Native ______Hispanic
______White
______Other (reserved for non- U.S Citizens) _______Asian/ Pacific Island
Are you a first- generation college student?

_______Yes

________ No

Applying for admission as: _____Freshman ______Transfer ______Transient ______Readmit

I am applying as a: ______ On-campus student _______Commuting student

Are you a Veteran? _______ If yes, do you plan to utilize your Veterans Benefits? ___________
Have you previously applied or been enrolled at Edward Waters College?__________________________________
If yes, what semester(s) and year(s)? ____________________________
Do you plan to earn a degree? ___Yes ___No Proposed major__________________________________________
High School attended_______________________________________City_______________________ State_____
Phone: ________________________
High School College Board code number (May be obtained from high school counselor) ______________________
Graduation Month _______________________Year_____________________ GPA________________________
Please List any university, college, technical institute, junior/ community college that you have attended:
_____________________________________________________________________________________________
Institution
City/State
Date Attended
Degree
_____________________________________________________________________________________________
Institution
City/State
Date Attended
Degree
_____________________________________________________________________________________________
Institution
City/State
Date Attended
Degree

Emergency Contact Person: _______________________________________________________________________

Relationship (Spouse, Parent, Guardian, Sibling, etc.): __________________________________________________
Home Phone: _________________________________ Mobile Phone: ____________________________________
Street Address: _________________________________________________________________________________
Street Address/P.O. Box
City
State
Zip Code

Mothers Name: ________________________________________________________________________________

Last
First
MI
Telephone Number: ___________________________________
Home

_______________________________________
Mobile

Fathers Name: ________________________________________________________________________________

Last
First
MI
Telephone Number: ___________________________________
Home

_______________________________________
Mobile

Please check area(s) of interest:

______Choir ______Band_______ Baseball_______ Basketball______ Cheerleading ______ Cross Country
______Football _______Golf ______Stunt Masters ______Track & Field ______Volleyball _______Softball

Legal Questions, Authorizations and Signature

Have you ever been convicted of or charged with a criminal offense (other than a minor traffic violation)?
___Yes ___No
Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere,
or an Alford plea to a criminal charge?

___Yes ___No

Have you otherwise accepted responsibility for the commission of a crime?

___Yes ___No

Have you ever been suspended or expelled from a secondary school system or an
institution of higher education for misconduct?

___Yes ___No

If your answer is yes to any of the questions above, please submit a full statement of relevant facts on a
separate sheet and attach it to this form. Your signature on this application authorizes Edward Waters College to
inquire about any matters referenced above, and authorizes those contacted to release information. If your
answer to either question changes to yes after submitting this application you must notify Edward Waters
College immediately.
Indicating yes to any of the legal questions above does not necessarily disqualify you from admission to Edward
Waters College, each case is reviewed on an individual bases. If it is discovered at anytime, before or after
admission to Edward Waters College, that you failed to be forthcoming and honest in your answers; this will place
you in jeopardy of a denial of admission or revoking of admission. Edward Waters College reserves the right to
exercise any of these options at anytime during the admissions process or during your matriculation at the College.
Edward Waters College also reserves the right to request/obtain a criminal background check at anytime on any
prospective or enrolled students. If requested, the background check would be at the students expense.
My signature on this application signifies that the information contained in my application is factually correct and
honestly presented, and I understand that to make false or fraudulent statements with-in this application may
result in disciplinary action, denial of admission and/or an invalidation of credits or degrees earned. If admitted, I
hereby agree to abide by the policies, rules and regulations of Edward Waters College. I understand that once I
sign and submit my application it becomes the property of Edward Waters College, and I agree to relinquish
ownership and waive my right to view it. Should any information that I have given change prior to my enrollment,
I shall immediately notify the Edward Waters College Office of Admissions.

Signature: _________________________________________________________ Date: ______________________

Parent/Guardian Signature (if under 18 years of age):________________________________ Date___________
Edward Waters College admits students without regard to race, color, creed, sex, religion, sexual orientation,
handicap and national or ethnic origin.

Essay
Please write a brief essay about the person, place or event that has had the greatest influence on your life; and
what influence you expect Edward Waters College to have on your future goals. This essay should be a minimum
of at least 300 words.

Term & Year of Proposed Enrollment

_____Fall (August)

Year 20____

_____Spring (January)

Year 20____