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Special Adult Student Certificate Program Application

To submit an application to our school, please complete the following form and select Submit Application.

= Required

Consideration for admission will be given to women and men who are at least 23 years of age. Each application is considered individually and the decision is based on (1) an admissions interview and (2) materials requested with the application (including this form, application fee of $30 made payable to Salem College, and an official, sealed transcript from your highest held degree. If no college or graduate level degree held, proof of high school completion will also be required).

Personal Information
Address Information
    Please enter your Primary address first.
Contact Information
  1. Phone Type Country Phone Number Primary
Demographic Information
Ethnicity and Race Information
  1. Are you of Hispanic/Latino ethnicity or descent? Yes No
    Select one or more races with which you identify yourself:
    American Indian or Alaska Native
    Black or African American
    Native Hawaiian or Other Pacific Islander
    2 or more
Citizenship Information
Academic Information

When selecting the period of time please note the following:

Fall begins in August

Jan is the January Term

Spring begins in February

  1. Program Commitment
Academic Interests
  1. Interests
Emergency Contacts

  1. Employer Name Position Start Date End Date
Education History

Please include all previously attended High Schools, Colleges, or Universities. Use the "Add Another Degree" link located to the right of the Education section for each additional institution attended.

High School Graduation - Use June 1st of the intended or actual graduation date.

College or University Graduation - Use the anticipated or actual date of graduation.

  1. Degrees


Character Data

If you answer Yes to the following question you will be required to provide the nature of the offense and actions taken.

School Policy
  1. Select "I accept" to confirm that you have read and fully understand the terms and conditions set forth in our Application Policy

    I do not accept I accept