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Evening Application

* = Required Field

ENROLLMENT INFORMATION

* I am applying for admission to Coker College for:    Year Term

* What location do wish to attend? * Academic status:

What is your intended major?

Hartsville
Lake City
Mullins
Cheraw/NETC
Bachelor of Social Work Business Administration Business Administration Bachelor of Social Work
Business Administration Sociology Sociology Business Administration
Education Bachelor of Social Work Bachelor of Social Work Education
Criminology Criminology
Psychology Psychology
Sociology

PERSONAL INFORMATION

* Title

* First Name

Middle Name

* Last Name

* Address

* City * State * County

* Zip/Postal Code * Home Telephone

* Sex * Social Security Number

* Date of Birth: Month Day Year (4 digits)

* Email (complete address or "none")


Coker College does not discriminate on the basis of race, color, creed, national origin, religion, ethnicity, gender or disability in the areas of admissions, employment, financial aid, or education services. While we ask for personal information on our application, such as race, ethnicity, gender, religion, country of citizenship and marital status, this information is voluntary and will used for reporting purposes only. The information will not be used as a factor in the admissions process or in a discriminatory fashion.

* Country of Citizenship Dual Citizenship? No Yes. If yes, what country?

Ethnicity Religion Marital Status

If married, spouse's name

Spouse's employer


EMPLOYMENT INFORMATION

Employer's Name

Employer's Mailing Address

City
State County

Zip/Postal Code Business Telephone


FINANCIAL AID AND BENEFITS

Check if Applicable

Active Duty Solider
Reserve/National Guard
Veteran

Will you use Veteran's Benefits?
No
Yes
If yes, you are required to submit form DD214 and check the appropriate programs listed to the right.

Chapter 30, New GI Bill
Chapter, 31 Vocational Rehabilitation
Chapter 32, VEAP
Chapter 34, Veteran
Chapter 35, Veteran Dependent
Chapter 1606, Selected Reserve

Does your employer have a Tuition Reimbursement Program? No Yes

Do you plan to apply for financial aid? No Yes

If yes, when will you complete the FAFSA? (mm/dd/yy)


EDUCATION

Please list, in order of date of enrollment, all educational institutions you have attended or are attending. (College policy requires full disclosure.)

* High School Last Attended * Years Attended

* H.S. Diploma or GED?

College, Technical School or University Years Attended

Degree Earned

College, Technical School or University
Years Attended

Degree Earned

College, Technical School or University Years Attended

Degree Earned

College, Technical School or University Years Attended

Degree Earned


OTHER INFORMATION

Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution? No Yes

Have you ever been convicted of or have an action pending for a misdemeanor or felony? No Yes

If you answered yes to either or both questions, you must submit give a separate statement in the box below that gives the approximate date of each incident and explains the circumstance(s).


Please discuss your career goals and/or reasons for attending Coker College:


Are you a legal resident of South Carolina? Yes No


Applicant, please read

To the best of my knowledge, the information provided in this application is complete and accurate. I agree to accept the regulations set forth in the Coker College catalog regarding academic standing, attendance, personal conduct and other matters, and to conduct myself in a manner that will reflect positively on the Coker College community. I accept that submitting this application represents my signature.


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DAY ADMISSIONS

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ALPHA ADMISSIONS

For Open House information or to visit the campus of your choice please contact Vicki Hudson (843) 383-8030 or vhudson@coker.edu.

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Contact Information

Office of Admissions (DAY)
Email:
admissions@coker.edu
Phone: 843.383.8050
Phone (Toll Free): 1.800.950.1908
Fax: 843.383.8056

Office of Admissions (ALPHA)
Name:
Vicki Hudson | vhudson@coker.edu
Email: alpha@coker.edu
Phone: 843.383.8030

Admissions Staff

Office of Financial Aid
Email: financial_aid@coker.edu
Phone: 843.383.8055
Phone (Toll Free): 1.800.950.1908
Fax: 843.383.8056

Financial Aid Staff

Coker College
300 East College Ave.
Hartsville, SC 29550