Orion College Application for Admission
Last NameRequired Entry
First NameRequired Entry
Date of BirthRequired Entry
SSN# (123-45-6789)Required Entry
Home Address:Required Entry
CityRequired Entry
StateRequired Entry
Country:Required Entry
Postal Code:Required Entry
Primary Email:Required Entry
Alternate Email:
Home Phone (xxx)xxx-xxxxRequired Entry
Cell Phone(xxx)xxx-xxxxRequired Entry
Work Phone/Alternate Contact:(xxx)xxx-xxxx
Emergency Contact PersonRequired Entry
Emergency Contact number: Cannot be the same as cell or homeRequired Entry
Nearest Relative(relationship to student)Required Entry
Nearest Relative Phone NumberRequired Entry
What is the best time to reach you?
 Morning 8am - 11am
 Day 12pm - 5pm
 Evening 5pm - 8pm
Name of High School/Secondary SchoolRequired Entry
CityRequired Entry
StateRequired Entry
Date of GraduationRequired Entry
Name of College (If any)
Are you employed? (Please complete below)Required Entry
Employer's Name
Employer's Phone Number
Postal Code
Select Admissions RepresentativeRequired Entry
Do you have a computer?Required Entry
Which program are you applying to?Required Entry
The fee to apply for admission to Orion College is a non-refundable application fee of $50.00(US currency.) This fee is used to administer the entrance exam and to process your application, transcript requests, and financial assistance applications. Thank you.
How did you find out about our program?Required Entry
Personal Information
Previous EducationRequired Entry
 High School
 Some College
 College Degree
 Masters Degree
EthnicityRequired Entry
GenderRequired Entry
Marital StatusRequired Entry
CitizenshipRequired Entry
Annual IncomeRequired Entry
Are you dependent or independent (please read below)Required Entry
Are you under the age of 18?Required Entry
If you are under 24, you are considered independent if any of the following applies to you:
1. A graduate or professional student.
2. Married.
3. A student with legal dependents other than a spouse.
4. A veteran of U.S. Armed Forces.
5. An active duty member of the U.S. armed forces (not for training purposes)
6. An orphan or ward of court.
Please provide the full name of your parent or legal guardian
Are you currently attending a school or college?
Please select oneRequired Entry
If so? Please provide name
Criminal Background Disclosure
Please be advised that you may be asked to furnish a background check prior to clinical/externship hours. If you have ever been convicted of, pled nolo contendere (no contest) to, or had adjudication of guilt withheld for any violation of any state or federal law in any jurisdiction, this may adversely impact your ability to obtain a certification/licensure or gain employment in the field for which you are trained.

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