Undergraduate Express Application

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Type of School School Name Major/Program of Study Degree Awarded When Was This Degree Conferred? When Was This Degree Conferred? School CEEB

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Disciplinary History

Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in disciplinary action? A history of disciplinary action does not automatically disqualify you from admission to Keuka College.

Yes

Please provide truthful and detailed information, including approximate dates of each incident, the surrounding circumstances, and your reflections on what you have learned from each experience.

A criminal conviction, whether it is classified as a felony or misdemeanor, does not automatically disqualify you from admission to Keuka College. However, it is essential to be aware that such a conviction might prevent you from participating in field or clinical placements, internships, or a professional practicum at certain sites or in specific majors.

Additionally, certain professions may impose restrictions on obtaining professional licensure based on your criminal history.

Have you ever been convicted of a crime (felony or misdemeanor) in any state or country?

Yes

Please provide truthful and detailed information, including approximate dates of each incident, the surrounding circumstances, and your reflections on what you have learned from each experience. This will enable us to offer you appropriate advising regarding your program of choice.

Sign and Submit

By submitting this application, I agree that all information is complete, factually correct and honestly presented. I understand that misrepresentation of facts on this application will be cause for refusal of admission, cancellation of admission, or suspension from the institution. By submitting this application, I agree to comply with the policies and regulations of Keuka College, and grant the College permission to use my photograph and name in College literature, on the College Web site, and for public relations purposes.

Type Your Full Name Below

Annual Security & Fire Safety Notice Keuka College's Annual Security and Fire Safety Report (ASR-AFSR) is available online. The Annual Security and Fire Safety Report includes Clery Act crime and fire statistics for the preceding three years for locations owned and or controlled by Keuka College, the required policy disclosure statements and other important safety-related information. A paper copy is available on request by contacting the Office of Campus Safety, North Duplex, 132 Central Ave., Keuka Park, NY 14478 during business hours or calling (315) 694-0268 and requesting a paper copy by mail.