Name Information

First Name

Last Name

Middle Name

Suffix

Preferred First Name

Last Name at Birth (Maiden)

SSN

Gender

Birth Date

Marital Status

Citizenship Information

Citizen Of

Citizen Status

Race Information

Race (Choose one or more)

Ethnicity

Person

Format

Candidacy Questions

The first question on this page allows the user to choose the year and then dynamically populates the term based on the response to the first question. The second question's data source has a place holder called ##CandidacyYear that is associated with the year question on the Options tab. Defining ## placeholders in data sources requires that another question on the form be associated with that placeholder to be used as an input in the data source at the time it is executed. 

What year do you plan to begin your studies?

If you intend to begin in January 2025, select the 2024-2025 academic year.

If you intend to begin in the summer (May) of 2025, select the 2025-2026 academic year. 

If you intend to begin in August 2025, select the 2025-2026 academic year. 

What term do you plan to begin your studies?

What type of student will you be?

Choose a program of study.

Contact Information

Address Line 1

Address Line 2

Zip Code

City

State

Country

Do you reside outside of the United States?

Have you lived in Ohio all of the last 12 months?

Have you lived in West Virginia for all of the last 12 months?

Primary Phone Number

Is your phone text capable?

Email Address

Confirm Email Address

Military Background

Are you a veteran of the United States Armed Forces?  Please check yes, if so

Selective Service Information

According to federal law, all male U.S. citizens must register with the Selective Service within one month after their 18th birthday. Male students aged 26 or younger must provide their Selective Service number to be eligible for financial aid. If you are required to have registered with the Selective Service, have you done so?

Selective Service Web Address

To register with the Selective Service, or to find your number, please visit www.sss.gov. Please notify the Belmont College Records Office as soon as possible with your Selective Service number.

Relationship

First Name

Last Name

Mobile Phone

Home Phone

Business Phone

E-mail

Confirm

Educational Background

Are you a high school graduate?

Did you participate in a College Tech Prep program while in high school?

Do you have a GED?

High School Graduation Year (eg. 2024)

Has your father graduated from college?

Has your mother graduated from college?

This control allows the user to enter multiple records for the questions defined. As the user begins typing, schools are suggested from a list of schools defined in the database. These are controlled by the Auto Complete Datasource setting on the question Settings tab. Upon choosing the school and degree, the user can click Save to add the school to the form and may add another. The save button executes the Grid: Add action and copies the data from the source questions to the associated Grid (Collection Grid).

Upon submission, each row in the collection grid will show up as an Organization Tracking row based on the J1 mapping.

Please include all previous high schools and colleges attended. Listing all previous educational institutions will expedite the application process. 

State of Institution

Institution

Name of Institution

Degree

Test Information

Test Code

Test Date

*Hidden Test Part Count

Test Part 1

Score 1

Test Part 2

Score 2

Test Part 3

Score 3

Test Part 4

Score 4

Test Part 5

Score 5

Document Upload (optional) ex: Test scores, Transient Forms, Transfer Clearance Forms

Please remember to send Official transcripts for all High School, College and Universities you list below.  Official transcripts can be mailed to the Records Office at 68094 Hammond Road, St. Clairsville, Ohio 43950.  Please contact the Records Office at 740-695-9500 if you have any questions about sending your transcripts.

Thank you for completing the application to Belmont College.  Please hit the finish button below in order to apply and receive information on next steps.