Name
Permanent Address
Re-entry term
Attendance Plan
Marital Status
Housing Plan
Unmarried students under the age of 21 must live on campus or at home with their parents or legal guardians.
You may enter more then one
Were you dismissed, suspended, or placed on probation at Kuyper or any of the schools listed above?

Acknowledgement 

  • I understand that a biblical Reformed theological perspective is core to the mission of Kuyper College. I have read the statement of faith and I agree to not engage in any activity that distracts from it. 
  • I acknowledge that my participation in the community of students, staff, and faculty and our care for each other as brothers and sisters in Christ requires me to sign and abide by the guidelines listed in the Student Handbook.  
  • I certify that the information provided on this application is accurate, to the best of my knowledge.   
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Date/Time
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Office Use

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Date/Time
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