ncclogo
Secure Online Application Form
Personal Information
First Name:
Last Name:
Middle Name:
Preferred Name:
Social Security #:
Maiden Name:
Street Address:
City:
State:
Zip code:
Email Address:
Phone:
Gender:
 Male Female
Date Of Birth :
Country Of Citizenship :
   
Ethnic Origin :
American Indian or Alaska Native Asian or Pacific Islander
Black (not Hispanic) Hispanic White (not Hispanic)
Marital Status :
Single Married Separated Divorced
Spouse's Name :
Parents/Guardian Name :
Parent Address :
Parent Phone # :
Father's Occupation :
Mother's Occupation :
 
Education
Ministry Majors :
Children's Ministry Worship Arts Family Life Counseling and Ministries
Preaching Ministry Christian Ministry Bachelor's Of Theology
Student Ministry Bible Based Teaching Education Deaf Ministry
World Missions General Studies Major Undecided / Undeclared
Type Of Application :
Freshman Transfer Special
First Application to NCC :
Yes No
Date To Enroll At NCC :
If No, Year Attended :
Will enroll as a :

Full-Time Student
 Part-Time Student

Graduating High School :
High School Address :
Graduation Date
Completed GED :
Yes No
ACT Test :
Yes No
ACT Date Taken :
ACT Score :
Plan Date To Take ACT :
   
Previous College Name :
Previous College Address :
Hours or Degrees Earned :
Date Attendance :
Previous College Name :
Previous College Address :
Hours or Degrees Earned :
Date Attendance :
 
Christian Commitment
Church Name :
Church Address :
Are You Member
Yes No
Substance Abuse
Illegal Drugs Alcohol Tobacco
Do you agree to discontinue use of Substance Abuse if enrolled at NCC ?
Yes No
Felony Conviction :
Yes No
If yes, when and what :
 
References
Please supply the names and Complete Mailing Address of Non-related people who would be willing to fill out a personal reference questionnaire.
A minister or church leader who serves at the church you attend (no relatives)
Reference Name 1:
Phone :
Reference Address/City/Zipcode 1:
Reference Name 2:
Phone :
Reference Address/City/Zipcode 2:
 
Special Interests
Basketball Men's Soccer Women's Volleyball Drama Worship Outreach
 
Statement Of Intent
Below please provide a 2 - 3 paragraph essay explaining your desire to prepare for Christian service at Nebraska Christian College:
 
I certify that the information I provided on this application is complete, accurate and true; and I agree to abide by the policies of Nebraska Christian College. I understand that any information given falsely or withheld will affect the decision on my application and make me ineligible for admission and/or enrollment or may be grounds for dismissal following enrollment.
Applicant's Intials
Date