I wish to enter as a student in the Gem City College, subject to the conditions of the catalog and the Regulations of the college. My health and physical condition are suitable for performance of the school Duties outlined in the catalog. My signature on this application for admissions also indicates that I am a citizen of the United States, and High School Graduate or I have been awarded a GED Certificate. The registration fee of $50 is enclosed. This application is not a contract. The college does not admit M-1 or F-1 students.

Last Name:

First Name:

Middle:

Maiden Name:

Street Address:

City:

State:

Zip:

Area Code:

Home Phone:

Cell Phone:

Email:

Born:

City:

State:

Birthday:

Month:

Day:

Year:

Name and Address of High School:

Year of Graduation:

GED Certificate:

College or Institution of Higher Learning Attended:

Address:

Course Desired:

Date of Entering:

Payment Method

We will contact you for your credit card information

Or, I am sending a check for the total amount

Send checks to:
Gem City College
700 State Street
Quincy, IL 62301
or call 217-222-0391