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I hereby apply for enrollment in Draughons College subject to the provisions of the College’s current catalog. The information on this Application for Admission is accurate, complete and true and any inaccurate, incomplete or false statement will entitle the College to deny admission to me.

* Fields with a red star are required.

Campus Location *	-- Select a Campus -- Bowling Green, Kentucky Clarksville, Tennessee Murfreesboro, Tennessee Nashville, Tennessee
Personal Information
First Name *
Middle Name
Last Name *
Maiden Name
Address *
City *
State *
Zip *
Home Telephone *
Cell Phone
Work Phone
Ext
Primary E-mail Address *
Other E-mail Address
Gender *	Gender Female Male
Date of Birth *	01 02 03 04 05 06 07 08 09 10 11 12 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 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Drivers License Number
Drivers License State
Emergency Contact Name *
Phone Number *
Relation to Applicant *
Emergency Contact Address *
City *
State *
Zip *
Responses to the following questions are voluntary and are used for state reporting purposes only.
Veteran *	Yes No
Disabled *	Yes No
Citizen *	Yes No
If no, Alien No.
Marital Status	-- Select One -- Single Separated Married Divorced Widow
Race	-- Select One -- African American White (Caucasian) Hispanic Other
Other Race
Transportation Information
Select all that apply   (hold ctrl to select more than one)	-- Select -- Bicycle Bus Fellow Student Friend Motorcycle My Car Relative Taxi Walk Other
Other Transportation
Academic Information
Program of Interest *
Class Time Preference *	-- Select -- Afternoon Evening Morning Weekend Online
Highest Level of    Previous Education *	-- Select -- High School Graduate GED Some College College Graduate
Name of High School Attended
Address
City
State
Zip
Date of Graduation
Date of GED Test
Testing Center
Name of Previous College
Address
City
State
Zip
Name of Previous College
Address
City
State
Zip
Admission to, employment by and promotion at Draughons Junior College shall be on the basis of merit, and there shall be no discrimination on the basis of race, color, creed, sex, handicap, or national origin. Draughons Junior College provides equal opportunity to all persons.
Applicants Initials *

 

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2421 Fitzgerald Industrial Drive - Bowling Green, KY 42101 | 1860 Wilma Rudolph Blvd. - Clarksville, TN 37040
415 Golden Bear Court - Murfreesboro, TN 37128 | 340 and 283 Plus Park Blvd. - Nashville, TN 37217
Toll-free 1-877-258-7796
© 2007 Draughons Junior College