Online Application for Admission to the 
Evening and Extended Studies Program

* = 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
Fort Jackson
Lake City
Mullins
Bachelor of Social Work Business Administration Business Administration Business Administration
Business Administration Sociology Sociology Sociology
Education Bachelor of Social Work Bachelor of Social Work Bachelor of Social Work
Criminology      
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

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

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.

Back to Admissions (without submitting application)

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