Welcome to the online application for the Jackson, Atlanta and Rome, GA Adult and Graduate Programs at Belhaven University. Please completely fill out this application and click the SUBMIT button at the bottom of the page to get your college application moving. An admission counselor will contact you upon receipt of your online form. Please note that information on your application fee payment will be provided once your online application is submitted. We are excited that you are applying to Belhaven and we look forward to serving you as you grow academically and spiritually.
Note: If you are applying to the Orlando Campus, please use this application.
If you are applying to the Chattanooga or Dalton Campuses, please use this application.
If you are applying to the Houston Campus, please use this application.
If you are applying to the Memphis Campus, please use this application.
| Institution | Location | Dates | Degree | Hours |
| Employer Name: | ||
| Employer Address: | ||
| Position Title: | ||
| Full Time Part Time | ||
| Length of Employment: | ||
Check here if you have less than the required minimum one year work experience with the same employer. |
||
| Self-Payment | Financial Aid |
| Employer reimbursement | Employer direct payment |
| (percentage or amount paid by employer) | |
| Veterans’ Benefits (contact the VA Representative at your campus for eligibility requirements) | |
| Other (please specify) | |
The following information is optional and does not affect the admission process. It is used for statistical purposes and to provide information required by the U.S. Department of Education in accordance with applicable federal regulations. An answer in each category would be appreciated.
| Country of Birth: | ||
| Country of Citizenship: | ||
| Country of Residence: | ||
| Veteran Status: |
| Gender | Ethnicity and Race Information | Marital Status |
|
Male Female |
Are you of Hispanic/Latino ethnicity or descent? Yes Select one or more races with which you identify yourself: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White |
Single Married Divorced Separated Widow |
* I hereby affirm to the best of my knowledge that all information on this form is complete and accurate and that any omission or misrepresentation may result in denial to the program, loss of credits, and/or dismissal from Belhaven University. I authorize Belhaven University representatives to request and receive from all schools I have previously attended (or am attending) copies of my academic records upon filling out the transcript request form. If enrolled, I agree to abide by all the policies of Belhaven University including, but not limited to, those represented in the catalogue and student handbook; I also give Belhaven University permission to send and supply news, photos and honors to my hometown newspaper and college publications.
| Applicant's Legal Signature: | ||
| (Type full name) | ||
| Today's Date: | ||
| Agreed acts as your signature: | Yes |
Belhaven University is committed to a policy of non-discrimination on the basis of race, color, sex, religion, handicap, age, or national/ethnic origin.
Once you submit this application, an admission counselor will be contacting you to let you know of any other necessary items to complete the admission process. Print a copy of this form for your records before pressing "submit."
