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  PERSONAL INFORMATION
  *First Name: *Last Name:
  *Street: 
  *City:  *State:  Zip Code: 
  *Email: 
  Date of Birth:     U.S. Citizen:  
  Gender:  Ethnicity: 
  PROGRAM OF INTEREST
 
SCHOOLS ATTENDED
  Attended College: 

College Attended: 
 

High School Graduate:

Name of High School:

GED Completion Date:

Name of Institution:

 
  EMERGENCY CONTACT INFORMATION  
  Name:

Phone Number:

Relationship:

 
     
  PERSONAL STATEMENT  
 
         
  I DECLARE under penalty of perjury that the statements and information submitted in this online application are true and correct.
I UNDERSTAND that all materials and information submitted by me for purposes of admission become the property of Helms College.
I UNDERSTAND that federal and state funds are available to assist me with the cost of college and that I can find out more by contacting the Financial Aid office.
   
  Type your full name as it appears on the application in lieu of electronic signature.
  *Electronic Signature: 
     


Apply Now was last modified: May 9th, 2017 by pittgroup