Student College Application

Student College Application

Please complete the application for the college admission. Type or print legibly. Once your form is complete, the admissions department will send a welcome letter to confirm your payment has been received, class date, time schedule and location. *These classes will be in-person at the Hampton VA campus.
Student Check List

Please be advised that this application includes a $50 registration fee at the conclusion. Send Identification and transcripts to agbc.central@gmail.com.
Personal Information
Full Name

First NameLast Name
Birth Date

MonthDayYear
E-mail
example@example.com
Phone Number
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
High School name
College Attended
Certificate Program (s) Completed
Graduated

YesNo
Graduation date

MonthDayYear
Name of Reference
Number of Reference
College name
GPA
Entry date

MonthDayYear
Date
Exit date

MonthDayYear
Date
Degree/ Certificate program

What Degree or Certificate program are you interested in enrolling in?
Choose a program
Please explain in the box why you are interested in the program you selected. (Optional)
Enrollment Agreement

The required registration fee of $50.00 is nonrefundable. Your signature is required and is the agreement to the financial terms of this application for enrollment.
Signature

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Application Fee $50.00*

USDApplication Fee

Credit Card

Cash App Pay

Student Check List