KING'S COLLEGE - First Year Academic Studies Program
Supplementary Application for Admission

To complete this application, be sure that you:
Submit a copy of test results, including WAIS-R subtest scores and current levels
of achievement in reading, mathematics and written language.

If you submit the online version of this form, it is acceptable to send the test results by regular mail.

Please note that all students must also complete an application for admission to
King's College and return it to:

Jacintha Burke, Director, Academic Skills Center
King's College, 133 North River Street
Wilkes-Barre, PA 18711

PERSONAL INFORMATION
Last Name:
First Name:
Middle Initial:
P.O. Box / Apt. #
Street:
City:
State:
Zip Code:
Phone Number: ( ) -
SCHOOL INFORMATION
When do you wish to enter King's College? Fall 20__   Spring 20__
Name of school you currently attend:
School Address:
Are you receiving services at the school? Yes No
If yes, how often?
Name of individual(s) providing services:
Title of the individual(s) providing services:
Do you receive private tutoring out of school? Yes No
If yes, in what subject(s)?
When was your learning disability first diagnosed?
Briefly describe, in your own words, how your learning disability affects your academic work.
Date of your most recent diagnostic evaluation.*
What support services do you feel are most important for your success in college?
In what academic areas do you feel most confident?
In what areas do you feel less successful?
What is your intended major? If undecided, what career do you think you might enjoy?