Worsham College

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Personal Information

Applicant's Name*

First Name Last Name

Maiden or Prior Last Name

For Transcript Verification

Address*

Street Address City State ZIP Code

Phone*

Email Address*

Desired Course Delivery / Starting Date*

I am a resident of Illinois, Indiana, Iowa, Michigan, Missouri, or West Virginia at least 30 days prior to the first day of classes.

Yes I Certify

I intend to have my embalming cases:

At the Medical Examiners Office with the School

At A Local Funeral Home

Personal Information – Part 2

Date of Birth*

Place of Birth*

If outside of the United States – Country of Birth

What gender do you identify with?

Are you of Hispanic, Latino or Spanish origin?

What is your race?

Marital Status

Contact Information / Work History

Parent / Guardian

First Name Last Name

Address of Parent / Guardian

Street Address City State ZIP Code

Phone of Parent / Guardian

Emergency Contact

First Name Last Name

Phone of Emergency Contact

Name of Current Employer

Phone of Current Employer

Are you related to anyone involved in Funeral Service?*

Yes

No

What is your relationship to the family member in funeral service and their name(s)?

(Mother Mary Smith, Uncle Bob Smith, etc.)

Have you previously attended a funeral service program?*

Yes

No

What is the name of the Mortuary College you previously attended?

Do you have any funeral service experience?*

Yes

No

How many months have you worked in funeral service?

Please enter a number from 0 to 100.

Education Background

High School Completion*

High School Name

City/State of High School

City State

Official high school transcripts will need to be sent to the school prior to acceptance.

What is the highest level of college education attained?*

I have completed this many hours of college credit

Please enter a number from 0 to 200.

Official Sealed College transcripts will need to be sent to the school prior to acceptance.

Name of College 1

Address of College 1

City State

Name of College 2

(If applicable)

Address of College 2

(if applicable)

City State

Name of College 3

(If applicable)

Address of College 3

(if applicable)

City State

Application Attachments

Personal Essay*

Personal Essay (400 to 500 words): Explain why you have selected funeral service for your career. (Allowed file extensions doc, docx, gdoc, pdf, jpg, jpeg, gif, png, bmp, tif or tiff)

Accepted file types: doc, docx, gdoc, pdf, jpg, gif, png, jpeg, bmp, tif, tiff, Max. file size: 256 MB.

Online Education Essay*

In 250-300 words, explain why online education is the right fit for you. (Allowed file extensions doc, docx, gdoc, pdf, jpg, jpeg, gif, png, bmp, tif, or tiff)

Accepted file types: doc, docx, gdoc, pdf, jpg, jpeg, gif, png, bmp, tif, tiff, Max. file size: 256 MB.

1st Letter of Recommendation

Submit a letter of recommendation from an individual familiar with your work performance and/or academic ability. (Allowed file extensions doc, docx, pdf, jpg, jpeg, gif, png, bmp, tif, or tiff)

Accepted file types: doc, docx, gdoc, pdf, jpg, gif, png, jpeg, bmp, tif, tiff, Max. file size: 256 MB.

You may also have the recommendation letters mailed directly to the campus c/o Registration Office.

2nd Letter of Recommendation

Submit a letter of recommendation from an individual familiar with your work performance and/or academic ability. (Allowed file extensions doc, docx, pdf, jpg, jpeg, gif, png, bmp, tif, or tiff)

Accepted file types: doc, docx, gdoc, pdf, jpg, gif, png, jpeg, bmp, tif, tiff, Max. file size: 256 MB.

You may also have the recommendation letters mailed directly to the campus c/o Registration Office.

Application Fee*

Price:

Total Charge

The information contained in this application is correct to the best of my knowledge*

I certify

Credit Card

Card Details

Cardholder Name

Personal Information

Personal Information – Part 2

Contact Information / Work History

Education Background

Official high school transcripts will need to be sent to the school prior to acceptance.

Official Sealed College transcripts will need to be sent to the school prior to acceptance.

Background Information

Application Attachments

You may also have the recommendation letters mailed directly to the campus c/o Registration Office.

You may also have the recommendation letters mailed directly to the campus c/o Registration Office.

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