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Application Form

Application For Admission
Printable Application (PDF)

If you should experience difficulty submitting this application, please contact our Office of Admission at (800) 233-3550, ext. 4278.
 

Application Instructions

  1. Complete and return this application to Blackburn College. No application fee is required.
  2. For freshmen and transfer students with less than thirty hours:
    *Submit the "Secondary School Report/ Transcript Request" directly to your guidance counselor.
    * Submit ACT and/or SAT results to Blackburn College.
  3. Transfer students, regardless of the number of semester hours completed, should submit official copies of all college transcripts.

Applicant Information

Last Name First Name Middle Initial

Preferred Name

Sex:  Male Female  Date Of Birth  

Street

City State Zip

County Country Phone

E-mail S.S.#

US citizen or permanent resident Yes No

Country of birth Alien registration number

Marital status: Single Married Divorced

Religious affiliation (optional)

If you are Presbyterian, Name of church

Minister's name  

Address

City State Zip

Ethnic origin (optional): Caucasian African-American Hispanic
American Indian Asian-American or Pacific Islander Other

High School Graduation Year

Enrollment Information

Are you applying as a: Freshman Transfer

Enrollment you are applying for: Full-time Part-time

Do you plan to live in on-campus housing Commute daily from home ?

Do you plan to apply for financial assistance? Yes No

Have you filed the FAFSA? Yes No

When do you wish to begin classes at Blackburn College? August (Fall semester) January (Spring semester) Indicate Year

Transfer Students

List colleges and dates you have attended beginning with the most recent.

College 1 College 2 College 3
Date 1 Date 2 Date 3

Semester hours earned Grade point average

Education Plans and College Interest:

Anticipate Major(s):

Career Goals:

Do you plan to graduate from Blackburn College: Yes No

I have applied or intend to apply to the following colleges:

I would like to participate in the following while at Blackburn College:

Activities:

Art Cheerleading Drama/Theatre Intramurals Leadership Prog. Music Piano/Organ Music Vocal Pompons/ Dance Team Student Government Yearbook/Newspaper

Varsity Athletics:

Baseball Basketball Cross Country Football Golf Soccer Softball Tennis (women) Volleyball

Prior or current work experience

Employer 1 Employer 2
Job Title 1 Job Title 2
Address 1 Address 2
Dates of Employment 1 Dates of Employment 2

In order of importance to you, list the scholastic honors, co-curricular and community activities in which you have participated:

Blackburn College provides scholarships for academic and work related skills. Please use the following space to describe the skill(s) you possess. How will the skill(s) benefit you at Blackburn College and how will the skill(s) benefit other Blackburn students?

Family Information:

Father or Guardian Mother or Guardian
Address Address
Phone Number Phone Number
College (if any) College (if any)
Highest degree earned Highest degree earned
Employer/Firm Employer/Firm

Name and ages of siblings

List any friends or relatives who have attended Blackburn College and their relationship to you:

By signing this application, I acknowledge that if I have omitted pertinent information, or have submitted inaccurate or false information, Blackburn College has the right to refuse or rescind admission.

Signature Date

Blackburn College is affiliated with the Presbyterian Church (USA). Blackburn College does not discriminate on the basis of sex, race, color, creed, age, physical handicap or national origin. This applies to all aspects of College life - including, but not limited to: hiring, recruiting and admissions, educational programs, housing, counseling, financial assistance, career planning, health and insurance benefits, services and athletics.

Copyright ©2005 Blackburn College. All rights reserved.