BENEDICT COLLEGE
School of Continuing Education
111 Doctor’s Circle, Columbia, SC 29203
(803) 705-4779
APPLICATION FOR ADMISSION
Applying for: ( ) Fall 20____ ( ) Spring 20____ ( ) Summer I 20____ ( ) Summer II 20____
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Last Name
First Name
MI
_____________________
Social Security #
___________________________________________ _________________________ _______ ______________
Street or P.O. Box
City
State
Zip
Phone Number (_____)______________________ Alternate Phone Number (_____)______________________
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E-Mail Address
_______/________/_______
Date of Birth
Gender ( ) Female ( ) Male
*Race or Ethnic Origin ( ) Black/African American ( ) White ( ) Hispanic/Latino ( ) American
Indian/Alaska Native ( ) Asian ( ) Native Hawaiian or Other Pacific Islander ( ) Nonresident Alien ( )
Race/Ethnicity Unknown ( ) Two or More Races
*Religious Denomination ( ) Baptist ( ) Methodist ( ) Catholic ( ) Other _____________________________
*This information is voluntary and is not used as a factor in admission decisions nor is it used in a discriminatory
practice.
Are you a veteran? ( ) Yes ( ) No
All students are required to have an official transcript from each institution
that they attended mailed directly to the School of Continuing Education.
Name of Institution
Location
Date(s)
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_______________________________________ _______________________________ _________________
_______________________________________ _______________________________ _________________
How did you hear about Benedict College School of Continuing Education? _____________________________
Intended Major ________________________________________________
Signature _________________________________________________ Date ______________________
Equal Opportunity in Education and Employment • Without Regards to Race, Sex, Color, National Origin, Religion or Disability