_____________________________________________________________Application
for Admission
Please read the application carefully before completing. Print clearly in blue or black ink. Be sure to complete
the entire application and required essays. Please bring your completed application with you when you come to
the information session.
Date of Application _______________ I am applying for term: Fall Spring of Year: __________
CONTACT INFORMATION
Full Legal Name (Last, First, Middle Initial)______________________________________________________________
Phone Number _____________________________________ Email Address ___________________________________
Current Address:
Street Address (including Apt. Number) _________________________________________________________________
City ______________________________________________________ State __________ Zip Code ________________
Mailing Address (if different than above):
Street Address (including Apt. Number) _________________________________________________________________
City ______________________________________________________ State __________ Zip Code ________________
If your mailing address is different than your home address, please explain:_____________________________________
_________________________________________________________________________________________________
PERSONAL INFORMATION
Social Security Number _____________________________ Date of Birth _______________ Current Age ___________
Birthplace (City, State, Country) _______________________________________________ Gender: Female Male
Native Language _______________________________ Language spoken in the home ___________________________
Race/Ethnic Background (This information is being requested on a voluntary basis for statistical purposes only. It will be
kept confidential. Failure to provide it will not affect your admission to Gateway to College.):
 American Indian  African American/Black  Asian/Pacific Islander  White  Spanish Surname/Latino Other ___________
Parent/Guardian Name (Last, First, Middle Initial) _______________________________________________________
Street Address (including Apt. Number) _________________________________________________________________
City ____________________________ State _______ Zip Code _____________ Phone Number ___________________
3400 Pershall Road • St. Louis, MO 63135-1408
St. Louis Community College is an equal opportunity/affirmative action institution.
EMERGENCY CONTACT INFORMATION (if different than Parent/Guardian)
Name (Last, First, Middle Initial) _____________________________________ Relationship_____________________
Street Address (including Apt. Number)________________________________________________________________
City __________________________ State _____ Zip Code ___________ Phone Number ________________________
ACADEMIC INFORMATION
How many high school credits have you earned to date? (This includes any alternative programs or college
classes you may have taken for high school completion and any coursework that has been approved for credit if
you were home-schooled.) __________
What school district do you live in? _____________________________________________
Please attach an official transcript from each source of high school credit.
List all high schools, alternative programs, home school, or college where you have taken courses, beginning
with the most recent. If you are working on or have earned your GED, please indicate below:
Name of School
Location
(City/State)
Dates
mm/yyyy to mm/yyyy
# of credits
earned
Transcript
attached?
Last grade
attended
Have you ever received Special Education Services, have or had an Individualized Education Plan (IEP) or a 504 Plan? Yes No
If yes, please answer the following questions:
Current or most recent school attended __________________________________________________________
Name of school counselor ____________________________________________________________________
What type of IEP do you have (or what kind of services were you receiving)? ________________________________
Have you ever taken the ACT or SAT? Yes
No
If yes, date of test: _______ Composite Score: _______
Are you currently enrolled in a GED program? Yes No If yes, name of program: ______________________
or an alternative program? Yes No If yes, name of program: ______________________________________
Have you taken classes at STLCC before? Yes No If yes, what year? ___________
Have you applied for any educational scholarships, grants or financial aid in the past year? Yes No
If yes, explain:
_________________________________________________________________________________________
If accepted into the Gateway to College (scholarship) program, you are not eligible to apply for, nor can you
accept, any form of financial aid through St. Louis Community College.
Have you ever been dismissed or suspended from a school or college for any violations of student conduct or safety? Yes No
If yes, please explain. What kind of support would you need to ensure that this did not occur again?
________________________________________________________________________________________________
Is there anything that may prevent you from attending classes on a regular basis? Yes No
If yes, please explain: ______________________________________________________________________________
Students accepted into the Gateway to College program are responsible for paying student activity fees.
How would you pay for fees? _______________________________________________________________________
STLCC/Gateway to College Required Essays (3 essays)
This essay portion of the application helps us become acquainted with you on a more personal level and is an
important step in the final acceptance by the Gateway Selection Committee. Your application is not complete
without your essays and will not be considered for acceptance without receiving them by the announced
deadline.
Directions: On separate sheets of paper, write answers to the three essay questions below. Each essay should be
at least two (2) paragraphs, in essay format, typewritten, and double-spaced. If you do not have access to a
computer or typewriter, you may neatly
hand-write your answers in ink. Please write your name on each page. Attach the essays to your application
form.
Please respond to all of the following questions:
ESSAY I__________________________________________________________________________________________
Section A
Please tell us about your strengths. What personal strengths have helped you to survive and/or to get back up and keep
trying? What strengths have helped you to make friends and/or to establish positive relationships with adults? What
strengths have helped you to say “no” to peers who try to distract you from your goals in life?
Section B
Tell us about some key personal problems or challenges that you have had that have interfered with your success in
completing your education in the past. (Some examples of challenges might be attitude, behavior, motivation, skills,
feeling accepted, cultural barriers, etc.)
Section C
What would be different now? Describe your commitment and motivation to overcome these challenges at this time in
your life.
How will the strengths you described above help you to overcome your challenges and to be successful?
ESSAY II__________________________________________________________________________________________
Why are you interested in being a part of St. Louis Community College’s Gateway to College program? Why do you
think this program is a good fit for you to achieve your goals? Why should the selection committee choose you for this
scholarship program, especially since there is a lot of competition for limited slots? Explain each area.
ESSAY III_________________________________________________________________________________________
Section A
As a full-time college student, how would you balance your coursework, employment, family, social and personal life?
What would motivate you to attend classes 100 percent of the time? What would motivate you to complete all your
homework assignments on time? Explain each area.
Section B
What steps would you take to ensure that your coursework/grades/academic success are a priority?
(application continued on next page)
Employment Information
Do you currently have a job? Yes No
If yes, please complete the following:
Employer _________________________________________________________________________________
How many hours per week do you work? _______________________
Location (City/State) ________________________________________________________________________
Type of work ______________________________________________
Actual days and hours you work each week ______________________________________________________
Referral Information
How did you learn about this program? __________________________________________________________
Required Signature
I certify that the information on this application is correct and complete. I understand that if I have not provided
accurate information or the required application materials, I may be denied acceptance into the Gateway to
College program.
I also understand that I cannot be enrolled in any other high school or other alternative high school education
program while participating in the Gateway to College program. If selected for the program, I agree to abide by
the St. Louis Community College Code of Student Conduct, as well as the policies and procedures of the
Gateway to College program.
St. Louis Community College is committed to non-discrimination and equal opportunities in its admissions,
educational programs, activities and employment regardless of race, color, creed, religion, sex, sexual
orientation, national origin, ancestry, age, disability or status as a disabled or Vietnam-era veteran and shall take
action necessary to ensure non-discrimination.
Applicant Signature __________________________________________________ Date _________________