Answer the questions below. All questions are required.
Do you have or have you ever had any significant physical or learning impairment?
Have you ever been treated for any nervous, mental, or emotional disorder, or seen a psychologist?
Have you in any way ever used alcoholic beverages, tobacco, or illegal or dangerous drugs?
Were you ever expelled, dropped, or suspended by any college?
Are you or have you ever been under the supervision of a parole officer or court, or charged with a violation of the law which resulted in or, if still pending, could result in probation, community service, a jail sentence, or the revocation or suspension of your driver's license?
For “yes” answers, give complete details in the explanation box provided. Include explanation
from the doctor, dean of students, court, or parole officer.