Application Fee:

$20.00 non-refundable

  

 
Responding to items with an asterisk (*) is voluntary.  No adverse action will occur if you choose not to answer them.
Admission Application Form
Prefix
Last Name
Legal First Name
Middle Name
Suffix
Maiden Name
Address
City  
State  
Zip Code
County
Home Phone Number
Cell Phone Number
Social Security Number Display as digits only, without dashes, e.g. 123456789
Gender  
Date of Birth   Day                      Month                     Year
Are you of Hispanic Origin?*

 

 

 

   If not, choose all that apply:*

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Email Address  
I intend to begin taking classes in:     Year
Please choose your intended field of study (major):  
If you intend to graduate from Edison, please tell us what credential you intend to earn:
If you don't intend to graduate from Edison, please tell us why you are choosing to enroll in classes now:
Marital Status:*  
Are you a U.S. citizen?     If not, indicate country of citizenship
Have you lived in Ohio for the past 12 consecutive months?  
Do you have any un-expunged felony convictions?  
Please choose one:   
Year of graduation or GED
Name the high school you have or will graduate from:
City, State, and Zip Code of the high school named above:  
Is this the first time you have attended college?    If no, please list all college attended:
  College Name:  
  Location:            
  Dates attended: 
Ohio Selective Service
Please choose one:
 
All applicants must complete this section.

I certify that I am registered with the Selective Service.  My Selective Service Number is  
If you are unsure what your Selective Service number is or haven't registered yet, please visit the Selective Service website at http://www.sss.gov/

  I am not registered with the Selective Service and qualify for exemption for one of the following reasons:
 
  • I am female.
  • I am under the age of 18.
  • I am over the age of 25.
  • I am currently on active duty in the Armed Forces of the United States excluding training in a reserve or National Guard Unit.
  • I am a nonimmigrant alien lawfully in the United States in accordance with section 101(a) of the Immigration and Nationality Act U.S.C. 1101, as amended.
  I am not registered with the Selective Service and do not qualify for any of the above exemptions.  I understand this may result in out-of-state tuition charges.
Are you a * Veteran?
  Single Parent? 
  Displaced worker?
  Child or spouse of a Veteran?
  Has either of your parents attended college?

I certify that the information on this application is correct and agree that false information or omission of data may result in denial of admission and/or awarding of financial aid, and may lead to suspension or dismissal from the College if discovered after acceptance.  I understand that the College may, at its discretion, conduct background checks on applicants.  I further agree that all transcripts and other documents submitted in support of my application become the property of the College.

Student Name:  
Today's Date:   

 

 Credit Card Payment information (Please allow 3-5 days for credit card processing.)

Credit Card Type:  
Credit Card Number:   enter xxxx xxxx xxxx xxxx 
Credit Card Expiration Date:     security code 
Cardholder Name:
Student Name:  
Questions?
        

 

 Piqua Campus - 1973 Edison Drive, Piqua, Ohio  45356 937-778-8600
Greenville Campus 601 Wagner Avenue, Greenville, Ohio   45331 937-548-5546
1-800-922-3722
www.edisonohio.edu