First Name
Middle Name
Street Address 1
Street Address 2
City
AK AL AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ---- AB BC MB NB NF NS ON PE PQ SK ---- Other State                  ZIP Code
       United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Chile China Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Dem. Rep. of Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equitorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fed. Rep. of Yugoslavia Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey & Guernsey Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Midway Islands Moldova Monaco Mongolia Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria N. Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Kitts & Nevis Saint Lucia St. Vincent & The Grenadines San Marino Sao Tome & Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Sahara Western Samoa Yemen Yugoslavia Zambia Zimbabwe Other Country

Home Phone Number
Work Phone Number
Religious Preference
If Methodist, what type?
Home Church

U.S. Resident?
Yes
No

Mississppi Resident?
Yes
No

Marital Status:
Single
Married
Separated
Divorced

Gender:
Male
Female

Semester Applying For:
Fall
Spring
Summer

High School Graduation Date

Intended Major

Housing preference:
On Campus
Off Campus

Application Status;
Freshman
Transfer
Evening
Adult Pathway
Special
Returning

Class Standing:
Freshman
Sophomore
Junior
Senior

Have you applied for Financial Aid?
Yes
No

Have you taken the ACT?
Yes
No
If so, when?
ACT Score
Have you taken the SAT?
Yes
No
If so, when?
SAT Score
High School GPA
College GPA (Transfer Students Only)

List all high schools and colleges you have attended, in chronological order, beginning with the present school. If a veteran, include military service and dates.

Last:
Name of School (Branch)
Date of Attendance
Diploma, Degree, Type of Discharge and Date

Next:
Name of School (Branch)
Date of Attendance
Diploma, Degree, Type of Discharge and Date

Next:
Name of School (Branch)
Date of Attendance
Diploma, Degree, Type of Discharge and Date

Next:
Name of School (Branch)
Date of Attendance
Diploma, Degree, Type of Discharge and Date

Next:
Name of School (Branch)
Date of Attendance
Diploma, Degree, Type of Discharge and Date

What Type of Financial Aid are you requesting?
Scholarship Only
All Scholarships and Financial Aid Available
You must complete the Free Application for Federal Student Aid (FAFSA) to receive any assistance
List Preference for Financial Aid below:
Loan Only must complete loan application and FAFSA
Work Study Only
Both
Note:You will automatically be considered for any non-repayable grants by completing the FAFSA.

Check any special skills or abilities you have:
Computer
Shorthand
Bookkeeping
Other (Please Specify)

If there are any unusual circumstances relating to your family situation which would help us determine your financial need, please explain.

Parents' Financial Statement:
Number of exemptions claimed for the period of this application
Name of Father
Occupation of Father
Age of Father
Name of Mother
Occupation of Mother
Age of Mother
Adjusted Gross Family Income (must equal a through c below)
a. Father's Income
b. Mother's Income
c. Applicant's Income
Any other Family Income (Social Security, Vocational Rehabilitation, V.A. Benefits, AFDC, Child Support, etc.)

Applicant's Financial Statement (Independent Students Only):
Number of exemptions for the period of this application
Adjusted Gross Income
Any other Family Income (Social Security, Vocational Rehabilitation, V.A. Benefits, AFDC, Child Support, etc.)
Did you receive any outside scholarship asistance?
Yes
No
If yes, how much?

Statement of Educational Purpose
I certify that I will use all funds received under the Title IV Student Financial Aid Program (loans, grants, and/or work study) only for espenses related to attendance at Rust College. I certify that I am not in default on any loans (Perkins or Stafford), and that I do not owe a refund on an educational grant.

I certify that I am not required to be registered with Selective Service because:
I am or have served in the Armed Services.
I have not reached my 18th birthday.
I was born before 1960.
I am a permanent resident of the Federated States of Micronesia, the Marshall Islands, or a permanent resident of the Trust Territory of the Pacific Islands.
I certify that I am registered with Selective Service.

Have you ever been convicted of a crime or felony?
Yes
No
If yes, please explain:

By submitting this application to Rust College Department of Admissions, I hereby certify that all information on this application is correct, that the opinions suplied are mine, and that the Office of Enrollment Services has my permision to contact those individuals I chose to provide you recommendation letters with regard to my admission to Rust College. I fully understand that any deliberate omission or falsification of information may result in denial of admission to or dismissal from Rust College.
I acknowledge I am willing to accept responsibility for my actions while a student of Rust College. Further, I agree, while enrolled at Rust College, to abide by all College policies including to but not limited to the examples which follow: academic policies; residence hall and housing policies; room contracts; computer use policies; general policies regarding co-curricular life; athletic policies; etc.
I understand that if I do not abide by these responsibilities, expectations, and polices, disciplinary action may result. I agree to withdraw my enrollment if I am unable to honor and abide by these responsibilities, expectations, and policies.

Or, you may contact: