Asbury College

1. Title Mr. Miss Mrs. Ms.
2. First name
3. Last name
4. Middle name
5. Birth date January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
6. Ethnic origin (optional) African-American American-Indian Asian Caucasian Hispanic Non-resident alien

1. Street address
2. City
3. State Select a State State Unknown Armed Forces Armed Forces Alaska Alabama Armed Forces Arkansas American Samoa Arizona California Colorado Connecticut Canal Zone District of Col Delaware Foreign Florida Fed. Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Marshall Island Michigan Minnesota Missouri N. Mariana Iss. Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming
4. Zip
5. Country United States Aruba Antigua and Barbuda Afghanistan Algeria Azerbaijan Albania Armenia Andorra Angola American Samoa (u.s.territory) Argentina Australia Ashmore and Cartier Islands Austria Anguilla Antarctica Bahrain Barbados Botswana Bermuda Belgium Bahamas Bangladesh Belize Bosnia and Herzegovinia Bolivia Myanmar(burma) Benin Belarus Solomon Islands Navassa Island (u.s.territory) Brazil Bassa Da India Bhutan Bulgaria Bouvet Island Brunei Burundi Canada Cambodia Chad Sri Lanka Congo (brazzaville) Zaire China Chile Cayman Islands Cocos Keeling Islands Cameroon Comoro Islands Colombia Northern Mariana Islands(uster Coral Sea Islands Costa Rica Central African Republic Cuba Cape Verde Cook Islands Cyprus Czech Republic Denmark Djibouti Dominica Jarvis Island (u.s.territory) Dominican Republic Ecuador Egypt Ireland Equatorial Guinea Estonia Eritrea El Salvador Ethiopia Europa Island French Guiana Finland Fiji Falkland Islands Federated States of Micronesia Faroe Islands French Polynesia Baker Island (u.s. Territory) France French Southern and Antarctic Gambia Gabon Georgia Ghana Gibraltar Grenada Guernsey Greenland Germany Glorioso Islands Guadeloupe Guam Greece Guatemala Guinea Guyana Gaza Strip Haiti Hong Kong Heard and Mcdonald Islands Honduras Howland Island Croatia Hungary Iceland Indonesia Isle of Man India British Indian Ocean Territory Clipperton Island Iran Israel Italy Israel-Syria Demilitarized Zon Ivory Coast Iraq Japan Jersey Jamaica Jan Mayen Jordan Johnston Atoll Juan De Nova Island Kenya Kyrgyzstan Korea, Democratic People's Rep Kingman's Reef Kiribati Republic of Korea Christmas Island Kuwait Kazakhstan Laos Lebanon Latvia Lithuania Liberia Slovakia Palmyra Atoll Liechtenstein Lesotho Luxembourg Latvia Libya Madagascar Martinique Macau Moldova Myotte Mongolia Montserrat Malawi Macedonia Mali Monaco Morocco Mauritius Midway Islands Mauritania Malta Oman Maldives Montenegro Mexico Malaysia Mozambique New Caledonia Niue Norfolk Island Niger Vanuatu Nigeria Netherlands Norway Nepal Nauru Suriname Netherlands Antilles Nicaragua New Zealand Paraguay Pitcairn Island Peru Paracel Islands Spratly Island Pakistan Poland Panama Portugal Papua New Guinea Trust Territory of the Pacific Portuguese Timor Guinea-Bissau Qatar Reunion Marshall Islands Romania Philippines Puerto Rico Russia Rwanda Saudi Arabia St. Pierre and Miquelon St. Christopher and Nevis Seychelles South Africa Senegal St. Helena Slovenia Sierra Leone San Marino Singapore Somalia Spain Serbia St. Lucia Sudan Svalbard Sweden South Georgia and South Sandwi Syria Switzerland United Arab Emirates Trinidad and Tobago Tromelin Island Thailand Tajikistan Turks and Caicos Islands Tokelau Islands Tonga Togo Sao Tome and Principe Tunisia Turkey Tuvalu Taiwan Turkmenistan Tanzania Uganda United Kingdom Ukraine United States of America Burkina Uruguay Uzbekistan St. Vincent and the Grenadines Venezuela British Virgin Islands Vietnam Virgin Islands Vatican City Namibia West Bank Wallis and Futuna Western Sahara Wake Island Western Samoa Swaziland Yemen Yugoslavia Zambia Zimbabwe Multiple Foreign Countries
6. Home phone
7. E-mail address

1. High school
2. City
3. State Select a State State Unknown Armed Forces Armed Forces Alaska Alabama Armed Forces Arkansas American Samoa Arizona California Colorado Connecticut Canal Zone District of Col Delaware Foreign Florida Fed. Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Marshall Island Michigan Minnesota Missouri N. Mariana Iss. Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming
4. Graduation year
5. High school GPA
6. Class rank of 
7. ACT Composite
8. SAT Verbal
9. SAT Math
10. If trasfer, College
11. If transfer, College GPA

1. My present interest in Asbury is Very strong Somewhat strong Uncertain

My extracurricular interests include...

I am interested in participating in the following intercollegiate athletics...
Not Interested
Cross Country
Men's Baseball
Men's Basketball
Men's Soccer
Men's Tennis
NCCAA Tournament
Swimming and Diving
Women's Volleyball
Women's Basketball
Women's Softball
Women's Soccer
Women's Tennis

I plan to visit campus
Yes Not sure No

I would like to meet an admissions representative if one is in my area
Yes Not sure No

My denomination or church affiliation is...
Assembly of God Anglican Bible Church Baptist (all Groups) Brethren Christian Church (all Groups) Church of God Church of Christ C & M Alliance Congregational Church of Christ, Christ Union Covenant Evangelical Free Evangelical Methodist Episcopal Evangelical (ecna) Free Methodist Friends Holiness (all Groups) Independent/community Independent Methodist Jewish Lutheran Mennonite (all Groups) Missionary Church Nazarene Orthodox (all Groups) Pentecostal Primitive Methodist Presbyterian (all Groups) Roman Catholic Reformed (all Groups) Salvation Army Southern Methodist United Brethren United Church of Christ United Methodist Unitarian(all Groups) Wesleyan Church None Other

Church name

Distance from home is...
A major concern Somewhat of a concern Not a concern

Financing my college education is...
A major concern Somewhat of a concern Not a concern

How did you hear about Asbury College?
Friend Relative Internet Pastor Parent is Alumnus Alumni relative Other Alumni Current student College carreer days Ichthus Guidance counselor Campus Life Magazine Asbury Brochures/Catalog Other publication Interweb FastWeb Other