Muffles Junior College
ONLINE APPLICATION FORM FOR DAY STUDENTS ONLY
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Day Students Only!
1)Applicant’s Full Legal Name (As it appears on birth certificate)
LAST NAME   FIRST NAME  MIDDLE NAME *
2) Address    Number Street   Village/Town/City *
3) PHONE      HOME     CELL *
4)Email Address *
5)Date of Birth: *
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6)Age as of August 1, 2024 *
7)Place of Birth: *
8) Gender *
9)Marital Status *
10)Citizenship *
11A)Secondary School Attended *
11B)Date entered into Secondary School *
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11C)Graduation Date Secondary School *
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11D)Other Secondary School Attended (optional)
12)Course of studies you pursued or are pursuing in high school
12B If you choose 'Other', please specify below
13A Have you sat the ATLIB Examination?
13B If you answered yes to 13A please state the date below.
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Associate Degree Offerings
14A) Indicate 1st CHOICE of program of study you wish to pursue at Muffles Junior College. *
14B) Indicate 2nd CHOICE of program of study you wish to pursue at Muffles Junior College.  Optional
14C) Indicate 3rd CHOICE of program of study you wish to pursue at Muffles Junior College.  Optional
15A) Father’s Name    First and Last
15B) Father's Occupation
16A) Mother’s Name    First and Last
16B) Mother's Occupation
17) Legal Guardian( if different from 15 & 16 above)
18A)Condition of Health *
18B) State any health condition that the school should be aware of:
19)Religious Affiliation (for statistical purposes)
20)Social Security Number
21) Personal Statement:  In your own words, submit a paragraph of approximately 100 words explaining why you wish to study at Muffles Junior College and how you expect this institution to help you grow professionally during your program of studies.  Feel free to share your personal characteristics and interests. *
22A) Acceptance of conditions for admissions
22B) FULL NAME *
22C) DATE *
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