CONFIDENTIAL FORM

OFFICE OF STUDENT AFFAIRS

Morris College

Sumter, South Carolina 29150

NOTE: For the Office of Student Affairs & Residence Directors

Last Name:

First Name:

Middle Name:

Age:

Date of Birth:

Place of Birth:

Home Address:

City:

State:

Zip Code:

Single Line Field

Phone:

Marital Status:

Divorced

Married

Other

Separated

Father's Name:

Father's Occupation:

Father's Place of Employment:

Father's Phone:

Mother's Name:

Mother's Occupation:

Mother's Place of Employment:

Mother's Phone:

Number of persons living at home:

Number in School:

Name of School last attended:

Dates of Attendance:

Location:

Your Career: 1st Choice

Your Career: 2nd Choice

Are there any subject(s) that you dislike?

To what club (s) do you belong?

Dou you play a musical instrument?

Yes

Which one?

What school office have you held before this year?

In what field do you expect to enter?

MEDICAL AND WELLNESS INFORMATION

(Note: A complete dental check-up, with x-rays is good insurance against dental problems. Also a complete eye check-up with drops is important for all students).

What limitation(s) have ever been placed upon the amount or character of your exercise?

When?

Why?

What are your special interests:

List any problems you might wish to discuss with your Residence Director or the Dean of Student Affairs.