Campbellsville University

Felony/Prior Conduct Applicant Questionnaire

"*" indicates required fields

Personal Information:

Full Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Email Address*

Program/degree you are applying for:*

Background Information:

Have you ever been convicted of a felony or misdemeanor? If yes, please provide details including the date, nature of the offense, and any penalties imposed.*

Yes

Details

Have you ever been subject to disciplinary action or suspension from a previous educational institution? If yes, please provide details.*

Yes

Details

Have you ever been involved in any criminal activity not resulting in a conviction? If yes, please explain.*

Yes

Details

Are there any pending criminal charges against you? If yes, please provide details.*

Yes

Details

Explanation of Offense:

Please provide a detailed explanation of the offense(s) you were convicted of or involved in, including the circumstances surrounding the incident(s).*

How have you demonstrated accountability and taken responsibility for your actions since the offense(s) occurred?*

Have you undergone any rehabilitation or counseling related to the offense(s)? If yes, please provide details.*

How do you plan to ensure that you do not repeat similar mistakes in the future?*

Reasons for Seeking Admission to Campbellsville University:

Why are you interested in attending Campbellsville University?*

How do you believe your experiences, including any prior conduct, can contribute positively to the Campbellsville University community?*

What academic and personal goals do you hope to achieve by attending Campbellsville University?*

How do you envision your future after completing your education at Campbellsville University?*

Is there any additional information you would like the admissions committee to consider when reviewing your application?

Declaration:

Signature*

Date*