Please provide the following information:          Click here for a printable version                                                          

Name
Street Address
P.O. Box
City
State/Province
Zip/Postal Code
Home Phone	example (000) 000-0000
Work Phone	example (000) 000-0000
Cell Phone	example (000) 000-0000
E-mail

Date of Birth	example mm/dd/yyyy
Sex	Male Female

Social Security Number(Optional)	example 000-00-0000
Father's Name
Mother's Name
Spouse's Name
With whom do you reside?

I wish to enroll for

Fall (Sept) Winter (Dec)

Spring (Mar) Summer (June)

Year planning to start
My schedule choice is	Day Evening/Weekend

Please check the program of study you would like to pursue. (Check one)

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Two-Year Associate Degree Business Administration	Two-Year Associate Degree Administrative Assistant	One-Year Certificate
Choose One Accounting Hospitality Management Information Technology Marketing and Management Undecided	Choose One Accounting Medical Office Technology Undecided	Choose One Medical Office Assistant Office Administration Undecided

Last high school  attended and any educational institutions you have enrolled in since high school

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Last High School Attended
Graduation Year
Guidance Counselor
GED (General Equivalency Diploma)
Year GED Received
College Attended Dates Attended
2nd College Dates Attended
Other Post High School Education
Dates Attended

Transfer Credit Requested	Yes	No

Extracurricular activities in high school / Honors received
Have you previously applied to JBC?	Yes No	Year
Have you visited the campus?	Yes No	Year
How did you learn of JBC?

 

Please provide names of three references who may be contacted by JBC:

1.

Name
Address
City			State				Zip Code
Phone
Occupation
Relationship to you
2.
Name
Address
City			State				Zip Code
Phone
Occupation
Relationship to you
3.
Name
Address
City				State				Zip Code
Phone
Occupation
Relationship to you
If you wish to identify yourself as a member of a racial/ethnic group, please indicate (Jbc will keep your response confidential and will not use the information provided in a discriminatory manner. Choosing not to respond to this question will not have any adverse effect on your application)
Non-Resident Alien Native American/Alaskan Native Hispanic/Latino Black (Non-Hispanic) Asian/Pacific Islander White

Conditions of Enrollment:

All policies of administration listed in the Jamestown Business College catalog, handbook, and compliance information, together with the following conditions, are understood to be accepted at the time of enrollment by the applicant and the applicant's parents or guardian.

I agree that any pictures taken by or for the college may be reproduced for publicity purposes.  Tuition paid in advance will be refunded, and unpaid tuition will accrue, according to the refund policy in effect at the time of withdrawal from the college.

Tuition is payable three weeks prior to the first day of each term.  Textbooks, fees, and supplies are not included in the tuition charges.

 

Privacy Policy

 

 

 

 

I certify that all information in this application is true and correct and without material omissions.  I understand that any incorrect, incomplete, or false information given by me is sufficient cause to void this application and/or terminate my enrollment.