2021-2022 Buckeye Career Center Adult Education Application for Full-Time Program Admission
$50 non-refundable Application Fee Required.
Last Name *
First Name *
Middle Initial
Maiden Name
Street Address *
Apt #
City *
State *
Zip Code *
County *
Social Security Number (necessary to look up FAFSA info as well as other items)
Date of Birth *
Home Phone *
Alternate Phone
email address *
Gender *
Marital Status *
Source of Income (Job, parents, spouse, etc.) *
I plan to enroll in the ________________ program for the 2021-2022 school year. *
What will your high school completion status be when you begin college in the 2021-2022 school year? *
High School Graduation Year or Date You Received GED *
List the name/address of the school which you received your Diploma/GED: *
List any schools you have attended since High School (School name, address, area of study, did you receive financial aid?): *
How do you plan to pay for your tuition and book fees? *
Have you ever been convicted of a crime? *
If yes, please explain.
Highest school your father completed: *
Highest school your mother completed: *
How did you hear about Buckeye Career Center? *
Student Certification (Please read and initial each line)
I certify the information given on this application is accurate to the best of my knowledge. *
I understand that all tuition & fees are due at the beginning of the program. If I am receiving financial aid, funds will come directly to the school to be applied to my account. Credit balances will result in a refund. If I am utilizing a payment plan, I will make the payments as arranged in the Enrollment Agreement. *
I agree to follow all Buckeye Career Center policies and procedures as stated in the student handbook. *
I understand that I must maintain satisfactory progress in my chosen training program (minimum 90% cumulative attendance and 2.0 grade point average- might be superseded by individual program requirements). *
I understand that should I withdraw (or be dismissed from) a training program, I will be responsible for all tuition & fees based on Buckeye Career Center's refund policy. (Policy located in student handbook) *
I understand that failure to maintain satisfactory academic progress will result in probation or dismissal from my training program and loss of financial aid. Anytime financial aid is lost, it might increase the amount I must pay. *
I realize Buckeye Career Center is required to share my educational progress information with any agency which may be providing financial assistance. I authorize the sharing of my educational progress information. *
I authorize Buckeye Career Center to share my educational progress information with prospective employers. *
I will share any sources of financial aid with the Financial Aid Administrator within 10 days of notification. *
I do hereby attest that the information provided above are true statements and realize that any false information is grounds for immediate dismissal. Print name and date. *
Buckeye Career Center conforms to all federal, state, and local laws and regulations including Title IX and nondiscrimination against any student because of race, color, creed, sex, religion, citizenship, economic status, marital status, pregnancy, handicap disability, age, or national origin. This policy of nondiscrimination shall also apply to otherwise qualified handicapped individuals.
Financial Aid
Leave blank if not applying for financial aid. Buckeye Career Center only processes Pell grants and does not process federal loans (Stafford loans, Direct loans, Parent Plus loans, etc).
Have you completed your FAFSA (https://studentaid.gov/)? Buckeye Career Center School Code: 030659. *
Do you need help completing the FAFSA?
Clear selection
Will you have other financial aid? Check all that apply.
If yes to scholarship, where is it from?
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