1-800-695-5550 
to Enroll!

CALL

1-800-695-5550 
to Enroll!

CALL

EARTH CITY CAMPUS
4260 Shoreline Drive  =  Earth City  =  Missouri 63045  | 314.344.4440

KIRKWOOD CAMPUS
10910 Manchester Road  =  Kirkwood =  Missouri 63122  | 314.965.8363

Admission Application...

We would appreciate it if you would take a few moments to answer the following questions. Please be assured that we do not share or sell personal information about you except when we have your permission.

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First Name
M.I.
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
E-mail Address
Phone
Cell Phone
Age
Maiden Name
Date of Birth
Marital Status
Explain
Number of Children
Ages of Children
Physical Problems
Parent/Guardian Name
Occupation
Parent/Guardian Address
Phone
Parent/Guardian Employer
Employer's Address
Employer's Phone
Present Employer
Phone
Education Completed
What was the last grade you completed in High School?
Name of High School
Actual/Expected Completion Date
College
Years Attended
Degree
Name
Address
Home Phone
Business Phone
Other
Are you satisfied with your existing job?
No, there is no future
No, it does not pay well
Yes
What has held you back from furthering your your career in the past?
Money
Spouse/Family
Lack of confidence
Lack of education
Lack of time
What motivates you?
Money
Self-esteem
Promotion/recognition
Excitement
Happiness
How do you rate yourself?
A mature person
Still room to mature
Lack responsibility
When it comes to Responsibility, I:
Enjoy assuming it
Would rather share it
Have trouble assuming it
When I run into a problem, I:
Ask questions
Figure it out
Have trouble assuming it
I would rate my level of commitment to school as:
None
Slightly
Moderately
Extremely
What kind of support do you have at home?
I am encouraged
I am discouraged
Indifferent
Does not pertain to me
How long have you been considering a career in this particular field?
Less than a month
One year or less
Several years
In school, what were your favorite subjects?
List three characteristics that make you valuable in the job market:
Where would you see yourself one year from now?
What situation might arise that would make attending classes difficult?
When was your last accomplishment that made you feel good?

PERSONAL HISTORY

PARENT OR GUARDIAN INFORMATION (IF UNDER 21 YRS)

STUDENT EMPLOYER INFORMATION

EDUCATION COMPLETED

IN CASE OF EMERGENCY

SELF EVALUATION

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