New APPLICATION FOR ADMISSION

APPLICATION FOR ADMISSION

Please provide all requested information on this form.

Last Name

First Name

Middle Name

Maiden Name or Other Names

Current Address

Street

Apt. Number

City

State/Province

Zip/Postcode

Home Phone

Cell Phone

Work Phone

Permanent Address (If Different From Above)

Street

Apt. Number

City

State/Province

Zip/Postcode

In Case of Emergency, Whom Should We Contact

Contact Name

Relationship

Cell Phone

Work Phone

Program in Which You Wish To Enroll

(Please Review College Catalog for Details on Each Program)

Program

Enroll In

Have you previously attended Commonwealth Institute?

Yes No Not Selected
If "Yes", please indicate the year

Previous College(s) Attendance

Please list all colleges attended and when

Which State do you plan to get licensed in?

The following information is requested and will not be used for unlawful purposes.

Social Security No

Gender

Birth Date

State of Residence

Country of Citizenship

Ethnicity

HS Graduation Date

Proof of Graduation Type

Highest Level of Education

First-time Student

Yes No

Name, Address & Phone of Funeral Home With Which You are Associated, if applicable

Commonwealth Institute of Funeral Service provides equal educational opportunities without regard to race, color, gender, sexual orientation, creed, age, national origin or disability.

• Please provide the $50 application fee at the end of this application.

• Please send the following: Official high school transcripts, or state agency granted G.E.D.; All Official transcripts of previously attended vocation/technical school, colleges or universities.

Student Certification

I certify that all information contained in this application is true, complete, and correct.

If accepted for enrollment at Commonwealth Institute of Funeral Service, I agree to comply with all of the rules and regulations of Commonwealth Institute and agree to hold Commonwealth Institute and their agents harmless from enforcing Commonwealth Institute’s rules, regulations and policies.

The undersigned applicant does release, and by these presents does release, acquit, discharge and forever hold harmless Commonwealth Institute, its agents, employees, representatives, insurers, officers, attorneys, and all other persons, firms, corporations, and entities from any injury (including exposure to infectious diseases), liability, responsibility, claims, causes, or right of action, of whatsoever kind, nature, or character, in contract or in tort, which have or may accrue to them or their heirs, successors, representatives, or assigns, of account of, arising out of, or by reason of the undersigned applicant participating in the course of study by, through, or under Commonwealth Institute. In executing this release, the undersigned applicant is relying solely and completely upon his/her own judgment, he/she does so of his/her own free will and accord, without threat, duress, or compulsions being directed against him/her. The undersigned acknowledges that this Release is a Full, Final and Complete Release. The undersigned applicant warrants that he/she has read this Release and fully understands it to be a release of all claims, known or unknown, present or future, that he/she may have against Commonwealth Institute, its agents, employees, representatives, insurers, officers, attorneys, and all other persons, firms corporations, entities, or other parties in interest released hereto arising out of the matter described herein. The undersigned applicant hereby represents that he/she is at least the age of eighteen (18), of sound mind, literate in the English language, and otherwise fully competent to execute this Release in all aspects.

Signature of Student

Application Date