A P P L I C AT I O N F O R

U N D E R G R A D U AT E A D M I S S I O N
P E R S O N A L D ATA (please print)
Secor
Alyssa
Christine
Legal name ______________________________________________________________________________
Last

First

Middle (complete)

Gender n Male n Female

Jr., etc.

12/13/1993
Birthdate ____________________

Preferred first name __________________________ Former last name(s) if any ______________________

2324
15
305
Social Security number________________________

Month

Area code

Day

Year

574 ) 276-0798
Cell phone (____________________________

219 ) 369-6542
Telephone (________________________
Number

Area code

3583 W. pawnee Dr.

Current mailing address __________________________________________________________

Number

Street

USA
La Porte
46350
IN
______________________________________________________________________________________________________________________
City

State

Zip

Country

pianoplayer1393@yahoo.com
E-mail address ____________________________________________________________
Citizenship
n U.S. or dual citizen (if dual, specify other citizenship) ____________________________________________
n U.S. Permanent Resident Number (original card will need to be presented) ____________________________ Expiration date ____________
n Other citizenship country(ies) ______________________

Visa type n F-I

n J-I

n Other __________

South Bend
IN
USA
City, state and country of birth __________________________________________________________________________________________
City

State

Country

What is your first language, if other than English? __________________________________________________________________________

How would you describe yourself?
Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture. n Yes
If no, please check all that apply
n American Indian or Native American A person with origins in any of the original peoples of North

n No

n Native Hawaiian/Other Pacific Islander Origins in

& South America (including Central America), who maintains tribal affiliation or community involvement.

any of the original peoples of Hawaii, Guam, Samoa or other Pacific islands.

n Asian Origins in any of the original people of the Far East, Southeast Asia or the Indian subcontinent; for example, n White Origins in any of the original peoples of Europe, the Middle East
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

or North Africa.

n Black or African American Origins in any of the black racial groups of Africa.
Marital status n Single n Married n Divorced n Separated n Widowed
Term of entrance n Fall (August) semester, 20 12
____

n Spring (January) semester, 20 ______ n May 20 ________

n Summer 20________

Application type n Freshman n Transfer n Guest n REACH n Nondegree n Audit

Status
Housing

n Full time

n Part time
n I plan to commute to campus

n I will need campus housing

Financial assistance Will you be applying for financial assistance? n Yes n No If yes, the FAFSA was or will be filed on __________________
If you have previously applied to Bethel, indicate the year you applied __________

Did you enroll? n Yes

n No

Date

AREA OF STUDY
A list of available majors is included with the application instructions. Please write the entire name of the major. If the major includes a concentration,
please list your choice of concentration. (please indicate your academic interest by selecting only one of the following options)
Graphic Design
Visual Arts
n Intended area of study ________________________________________________________________________________________________
Major

Concentration

n Exploratory/undecided (indicate possible area of study) ________________________________________________________________________

What type of degree do you expect to complete?

n Bachelor (4-year)

n Associate (2-year)
Web App ID: 12112

OFFICE USE
11/28/2011
Date received ______________________
/
Decision ____________
ac

ec

Application fee ____________________

Counselor ____________

ID __________________

______________________________________________________________________________________________

H I G H S C H O O L E D U C AT I O N
Home School
High school__________________________________________________________
46350
IN
La Porte
Address ____________________________________________________________
City

State

Type of school (check one) n Public

n Private

n Parochial

2012
Date of graduation ________________________________
High school CEEB code ____________________________

Zip

n Home school

Guidance counselor __________________________________________________

)
School telephone (________________________________

Name

Area code

Number

Testing and Course Information

Official test scores must be submitted before an admission
decision can be made. Please list your test plans below.

Please list senior courses to be completed.

First Semester
Second Semester
Pre-Calculus
and Trigonometry
Pre-Calculus
and
Trigonometry
____________________________________________

Dates taken
SAT
______________
6/11
ACT
______________
TOEFL ______________

Anatomy and Physiology

Economics
____________________________________________
Vocabulary Word Study
Fundamentals of Accounting
____________________________________________
Fundamentals of Accounting
Anatomy and Physiology
____________________________________________
____________________________________________
____________________________________________

or

To be taken
________________
4/12
________________
________________

ACADEMIC HONORS
Briefly describe any scholastic distinctions or honors you have earned. (attach additional pages if necessary)
homeschooled
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
EXTRACURRICULAR AND PERSONAL ACTIVITIES
List your principal extracurricular, community, church, family activities and hobbies in the order of interest to you. Include specific events and/or major
accomplishments such as musical instruments played, offices held, varsity letter earned, etc. (attach additional pages if necessary)
Activity
9

Grade level
10 11 12

Positions held, honors won

or varsity letters earned

(3) Plan to
participate at BC

Campus Life
______________________________________________________________________________________________________________________

Violin
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

COLLEGE/UNIVERSITY EXPERIENCE
Please list all colleges where you have taken courses for credit and have official transcripts sent to the Bethel admission office from each institution.
Name of college

Location (city, state)

Dates attended

Degree earned

______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

WORK OR VOLUNTEER EXPERIENCE

List any jobs (including summer employment and volunteer work) you have held during the past three years. (attach additional pages if necessary)
Employer
Nature of work
Dates employed
Hours per week
8
Lamb's Little One's Preschool
Teacher's Aid
9/2011______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________

C H U R C H I N F O R M AT I O N
State Street Community Church
Church name ____________________________________________________

I
Denomination ____________________________________

La Porte
IN
46350
Address __________________________________________________________________________
City

Pastors name

State

Zip

Nate Loucks
__________________________________________________

) 219-575-7182
Telephone (________________________________________
Area code

Number

F A M I LY
With whom do you make your permanent home? n Mother n Father n Both n Spouse n Other
If spouse or other, please provide name and relationship, then continue to Siblings/Children section.
Mark and Julie Secor
Mother and Father
Full name(s) _________________________________________________
Relationship to you ____________________________________
PA R E N T S
Parents marital status n Married n Widowed n Separated n Divorced
Father

Secor
Mark
Eugene
Legal Guardian Name _______________________________________________________________________________

Living? n Yes n No

secorme@gmail.com
( 219 ) 3696542
Daytime telephone ____________________________________
E-mail address ____________________________________

Mother

Last

Area code

First

Middle

Number

3583 W. pawnee Dr.

46350
LaPorte
IN
Home address if different from yours _________________________________________________________________________________________
Street

City

State

Zip

CFO
Horizon Bank
Occupation ______________________________________________________________________________
Faith based organization? n Yes n No
Title

Name of business or organization

William Penn University

Business and Accounting
College(s) attended (if any) _____________________________________________________
Degree(s)/year(s)______________________________
Father

Secor
Julie
Marie
Legal Guardian Name _______________________________________________________________________________

Living? n Yes n No

marksecor@netzero.net
( 219 ) 3696542
Daytime telephone ____________________________________
E-mail address ____________________________________

Mother

Last

Area code

First

Middle

Number

3583 W. pawnee Dr.

46350
LaPorte
IN
Home address if different from yours _________________________________________________________________________________________
Street

City

State

Zip

Occupation ______________________________________________________________________________ Faith based organization? n Yes n No

Title

Name of business or organization

College(s) attended (if any) _____________________________________________________ Degree(s)/year(s)______________________________

SIBLINGS/CHILDREN
Please provide the name(s)/ages of your brothers/sisters or children. If they are attending high school or college, list the school(s) and graduation year(s).
Full name
Age Sibling () Child () High school or college attending Graduation year
Secor, Tyler Eugene
22 Brother
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
BETHEL COLLEGE LEGACY
Please list relatives who have attended or who are attending Bethel College.
Full name
Relationship
Graduation year
Degree earned
1959
Grandparent
Bachelor of Arts
Secor, Larry
______________________________________________________________________________________________________________________
Bachelor of Arts
Aunt/Uncle
Banks, Rita
1958
______________________________________________________________________________________________________________________
Engbrecht_, Scott
Bachelor of Arts
1997
Cousin
______________________________________________________________________________________________________________________
Cousin
Engbrecht-Beall, Kimberly
Bachelor of Arts
2000
______________________________________________________________________________________________________________________
P E R S O N A L S TAT E M E N T See attachment 12112
A personal statement is required and is vital to the review of your application. Not only will your statement provide a greater understanding of who you
are, but will also allow the admission committee to assess your ability to organize and express your thoughts. Please submit a one- to two-page (300-400
words) personal statement focusing on one or more of the following topics:
Your academic ambitions
Your career objectives
Your statement of faith or ministry goals
Your reason for applying to Bethel College
LETTER OF REFERENCE
Applicants should submit a letter of reference as part of the application process. The reference should be from your pastor, youth pastor or a high school
teacher from one of your core academic courses. You may use the reference form that is included with this application, or ask that a letter of reference be
sent directly to the Bethel College office of admission. Please indicate who will be submitting a letter of reference.
Nate Loucks
Name ______________________________________________________

Pastor
Position ________________________________________________
Application continued on back

A D D I T I O N A L I N F O R M AT I O N
How did you first learn about Bethel College? (please check only one)
n
n
n
n
n

High school guidance counselor

High school coach
High school visit by admission counselor
College fair
Pastor/Church

n
n
n
n
n

n
n
n
n
n

Bethel coach
Bethel student
Bethel alumnus
Bethel faculty/staff
Web/Internet

Radio/newspaper
Bethel publications
College guidebooks
Parents/brother/sister
Other ____________________________

To what other colleges have you applied, or are you expecting to apply for admission?
Olivet Nazarene University
Bourbonnais
IL
1. ____________________________________________________________________________________________________________________
College

City

State

College

City

State

Grace College
IN
Winona Lake
2. ____________________________________________________________________________________________________________________
3. ____________________________________________________________________________________________________________________
College

City

State

4. ____________________________________________________________________________________________________________________
College

City

State

What factors will most affect your college choice?

Environment
1. ____________________________________________________________________________________________________________________
Location
2. ____________________________________________________________________________________________________________________
3. ____________________________________________________________________________________________________________________
What is your hometown newspaper?________________________________________________________________________________________
Newspaper address ______________________________________________________________________________________________________
City

State

Zip

Disciplinary History
Have you ever been found responsible for a disciplinary violation at any school attended (9th grade forward), whether related to academic or behavioral misconduct,
that resulted in your probation, suspension, or expulsion from the institution? n Yes n No
Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? n Yes n No
If yes to either or both questions, please attach a separate sheet of paper that gives the date of each incident, explains the circumstances, and reflects on what you learned.

COMMUNITY LIFE COVENANT

Bethel College respects your integrity as an individual. At the same time, your life is expected to be consistent with the ideals and purposes of a Christian
community. It is the position of the college that such things as alcoholic beverages, tobacco, habituating drugs, profane language and improper behavior
or attire cannot be a part of the Bethel experience. Therefore, students are held to this position. When Bethel students show respect for order, honesty,
courtesy and a high standard of morality, they are interacting in a manner that promotes the college ideals. Worship is also important at Bethel. The
college provides chapel programs three times per week and attendance at these services is required. Bethel College seeks to enroll students who are in
agreement with the spirit and ideals of the college and who will have a positive influence on their fellow students.
A P P L I C A N T S TAT E M E N T
I hereby apply for admission to Bethel College and I agree to abide by the rules and regulations of Bethel College as stated above, in the college catalog
and the student handbook. With this in mind, I realize that actions on my part that do not agree with the guidelines of conduct established by the
college may result in forfeiture of any or all Bethel College sponsored scholarships. I hereby certify that all information provided on this application is
correct. I understand that withholding information on my application for admission or giving false information may make me ineligible for admission
to Bethel College or may subject me to later dismissal.
Alyssa C Secor
Signature ________________________________________________________________________

11/28/2011
Date ______________________________

(To be signed by applicant)

Any offer of admission to Bethel College prior to the applicant's completion of high school is provisional,
subject to successful academic work during the remainder of high school and proof of graduation, except for
candidates who are applying for college entrance without high school graduation. Any offer of admission to an
applicant transferring from another college is provisional subject to successful completion of course work in
progress at the time of application and proof of good standing from the previous college. All application materials
become the property of Bethel College. The Bethel College catalog and student handbook are available at
www.BethelCollege.edu.
Within the context of its religious principles, heritage and mission, Bethel College admits students of any race, national or ethnic origin, age or gender
to its programs and activities. It does not discriminate in the administration of its educational policies, admission policies, scholarship and loan programs, athletic or other college-administered programs. The college makes every reasonable attempt to accommodate students with limiting physical
impairment; however, each school reserves the right to examine applicants for suitability for the participation in the educational activities of the school.

1001 BETHEL CIRCLE

MISHAWAKA, IN 46545-5591
800.422.4101 574.807.7600
FAX 574.807.7650
admissions@BethelCollege.edu
www.BethelCollege.edu