JLC Application for Admission

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Please give us the following information about yourself. Note that fields marked in bold are required.
Firstname:
Middle Name or Initial:
Lastname:
Suffix:
What name do you prefer to go by?
Date of Birth:	MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember    Day12345678910111213141516171819202122232425262728293031    Year199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937
Gender:	Your Gender...FemaleMale
Address:
City:
State:	Choose one... Not ApplicableAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelewareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginaWashingtonWest VirginiaWisconsinWyoming
Zip or Postal Code:
Country:	Choose one...AustraliaAustriaAzerbaijanBelarusBelizeBosnia and HerzegovinaBrazilBulgariaCambodiaCanadaCayman IslandsChinaCosta RicaCubaCzech RepublicEgyptEl SalvadorEnglandEthiopiaFranceGambiaGermanyGhanaGhanalaGreeceGuatemalaHondurasHong KongIndiaIndonesiaIrelandIsraelJapanKenyaKoreaMalaysiaMexicoMoroccoNairobiNepalNicaraguaNigeriaNorthern IrelandNorwayNova ScotiaOmanPakistanPanamaPeruPhilippinesRomaniaRussiaRwandaSerbia & MontenegroSingaporeSouth AfricaSouth KoreaSpainTaiwanThailandTurkmenistanUnknownUSAUzbekistanVenezuelaVietnam
International State, Province or Territory:
Phone Number:	( )   -
E-Mail Address:
Who do you live with:	Choose...Both ParentsFatherMotherLegal GuardianSpouseNone of these
Are you married?	Choose...YesNo
If "Yes," what is your spouse's name?
Firstname:
Lastname:
How many dependents do you have?

 

*If you prefer to download and print the Jones Learning Center application for admission and supporting forms, visit http://departments.ozarks.edu/jlc/apply/appforms.asp.

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