Admissions Application

Call (760) 328-5554 or submit this form to learn more about Mayfield College!

PERSONAL INFORMATION:

First Name:
Last Name:
Address:
City:
Zip Code:	(xxxxx)
State/Province:
Country:
Email:
Phone Number:	( ) - Mobile Home Business
Gender:	Male Female
Date of Birth:	/ / (MM/DD/YYYY)
Which program are you interested in?:

SCHOOL INFORMATION:

Have you graduated from high school (or received a GED certificate)?:	Yes No
If Yes, what year?:	(xxxx)
If No, would you be interested in our Free GED preparation course?:	Yes No
Have you attended college before?:	Yes No
If yes, did you graduate from college?:	Yes No
Extracurricular activities (such as community or school involvement):

EMPLOYMENT INFORMATION:

Current Employer:
Position:
Duties:
Hours worked per week:

METHOD OF PAYMENT:

Have you set money aside for your education?:

Yes No

Will you be seeking financial assistance?:

Yes No

Select One:

		I will pay for my entire term charges on or before registration.
		An authorized company or agency will pay my entire charges each term.
		I will require financial aid to help pay my term charges.

By submitting this form, I agree to this website's Privacy Policy and I authorize Mayfield College to contact me regarding educational services via text, email and/or telephone at the email address and/or phone numbers provided. I understand this authorization is not required to attend Mayfield College and if I do not wish to consent, I can call (760) 328-5554 for more information.