Please fill out the entire form carefully and furnish complete information; failure to do so may result in a processing delay. Please do not use quotation marks in any of your responses. (* indicates a required field)

Applicant Information

1. Last Name *
2. First Name *
3. Middle Initial
4. Preferred Name
5. Home Phone Number -
6. Cell Phone Number -
7. Email Address
8. Social Security Number--
9. Permanent Street Address *
10. Town/City *
11. State * Select your state... Not in United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
12. Zip/Postal Code
13. Date of Birth (MM/DD/YYYY) * January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950
14. Are you: First Time Student  Transfer Student  Returning Student 
15. Your class level when you come to Mars Hill: Freshman  Sophomore  Junior  Senior 
16. Term of enrollment* Fall Spring
17. Year * 2012 2013 2014 2015
18. Have you ever been convicted of a felony? Yes   No
19. If so, please explain
20. Do you have any illnesses or disabilities which require special housing or consideration? Yes   No
    If "yes," you will need to register with Disability Services.

Contact Now Emergency Information

1. My cell phone number (or best number for reaching me in an emergency)
2. Emergency contact's name (parent or other family member)
3. Emergency contact's cell phone number
4. I understand that Mars Hill College will use my personal cell phone number and other information in conjunction with the campus emergency management system, "Contact Now." I understand that this information will be used exclusively for emergency and other priority notifications by the college. I understand that if I refuse to provide my contact information, I cannot be notified in case of an emergency or crisis on campus.    Check here to confirm
      Check here if you do not have a cell phone

Meal Plan Choices

1. Unlimited Plan (includes Unlimited swipes in Pittman Dining Hall, plus $100 Bonus Bucks) - $2,070 per semester
   
   Apartment Plan (includes 150 meals per semester, plus $100 Bonus Bucks)- $1,200 per semester
   

Acknowledgement of Contract

1. I have read the commuter requirements in the Residence Life sections of the Mars Hill College Student Handbook and agree to abide by them, as well as all the rules and regulations of Mars Hill College. I understand that cancellations must be made in writing and that I am liable for appropriate cancellation fees if this contract is cancelled. I agree to pay Mars Hill for food service charges for the length of the contract. All contracts are for the full academic year while school is in session and do not include extended breaks or summer. Mars Hill College offers its living accommodations to MHC students without regard to race, color, religion, or national origin on a space available basis.    Student (or parent/guardian if student is under 18) check here to sign this contract
      Name of person signing contract
      In lieu of an actual signature, please provide the name of the city where you were born, to serve as verification
2. Commuter deposit is $150, which is refundable until May 1 of the calendar year of enrollment. You may mail your check or money order to:
        Mars Hill College
        P.O. Box 6663
        Mars Hill, NC 28754.
   If you would prefer to pay by credit card, please call the admissions office at 866-MHC-4-YOU (online payment is currently unavailable).