APPLY TODAY

ELIGIBILITY

If you do not meet any or all of the next 4 requirements, please complete them or contact us with any questions.

I agree I am 17 years of age or older, and have completed High School or received GED. *

Yes, I meet the above requirements.
No

If no, please explain.

I have a valid drivers license. *

Yes, I meet the above requirements.
No

If no, please explain.

APPLICANT INFORMATION

First Name *

Last Name *

Birthdate *

Current Age *

Gender

Male
Female

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email *

Are you a citizen of the United States *

Yes
No

If no, please elaborate.

ACADEMIC OVERVIEW

What is your highest form of education currently? *

Where did you graduate High School or receive your GED? *

Graduation or GED Completion Year *

If Other, please elaborate.

What do you think are your academic strengths & weaknesses? *

Will you have a personal laptop to use while at CLC? (Due to online courses, a latop is required.)

Yes
No

FINANCIAL OVERVIEW

Are You Currently Employed? *

Yes
No

If Yes, where?

Do you have any current debts? *

Yes
No

If Yes, explain

How do you plan to pay for tuition? *

Do you have your own vehicle?

Yes
No

CHURCH HISTORY

What Church are you currently involved with? *

How long have you attended church regularly? *

List the different ministries you were involved with. *

Please share your salvation experience. *

Pastor's Reference *

First

Last

Pastor's Phone Number *

QUESTIONNAIRE

Why do you want to attend Crossroads Leadership College? *

How do your parents or guardians feel about you attending Crossroads Leadership College? *

How would you rate your mental health (1 being worst & 10 being best)? *

What are your interests or hobbies? *

What is a challenge you have faced and how did you overcome it (or are working towards overcoming)? *

Upon enrollment we run a standard background check on each student. We have the responsibility to ensure that CLC is a safe environment for everyone and would prefer to hear directly from you, the applicant. An arrest or conviction will not necessarily disqualify an applicant for enrollment. Have you ever been arrested or convicted?

Yes
No
I have questions

If Yes, why?

We require all students to be nicotine and alcohol free during the school year. Do you understand and agree to abide by this standard? *

Yes
No
I have questions

Is there anything else you wish to share? *

By submitting this form you confirm that all information provided is correct and true to the best of your knowledge. *

I Confirm

Personal Photo

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