Legal History Explanation

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This field is for validation purposes and should be left unchanged.
You indicated on your application for admission that you have been convicted or plead “no contest” to a violation of law (other than minor traffic offenses). Please provide detailed answers to the questions below.
Name*
First Middle Last
Date of Birth*
Please provide the email address you used when applying for admission.*

You indicated on your application for admission that you have been convicted or plead “no contest” to a violation of law (other than minor traffic offenses). Please provide detailed answers to the questions below.
What were you arrested or ticketed for? Please include a thorough description of these circumstances and what led to all of your arrests and the charges brought against you.*
Have you been convicted of a felony?*
- Yes
- No
If yes, how many?*
What were you convicted of and in what city and state did this take place? (this may be different than what you were arrested for)*
What was the outcome of your conviction(s) (i.e. probation, fines, incarceration, etc…please list all outcomes)*
What was the date of the conviction/outcome? (mm/dd/yyyy)*
Has the time or sentence been served and/or outcome been satisfied?*
- Yes
- No
If no, please explain below*

You indicated on your application for admission that you have been convicted or plead “no contest” to a violation of law (other than minor traffic offenses). Please provide detailed answers to the questions below.
Have you been convicted of a misdemeanor?*
- Yes
- No
If yes, what class of misdemeanor (check all that apply):
- Class A
- Class B
- Class C
What were you convicted of and in what city and state did this take place? (this may be different than what you were arrested for)*
What was the outcome of your conviction(s) (i.e. probation, fines, incarceration, etc…please list all outcomes)*
What was the date of the conviction/outcome? (mm/dd/yyyy)*
Has the time or sentence been served and/or outcome been satisfied?*
- Yes
- No
If no, please explain below*

By my signature below, I attest that the information provided above is true and correct to the best of my knowledge. Further, I authorize Regent University to contact me to confirm the accuracy of the above information.*
By my signature below, I attest that the information provided above is true and correct to the best of my knowledge. Further, I authorize Regent University to contact me to confirm the accuracy of the above information.
Please note that completed forms must include a valid signature. Forms submitted without a signature, will not be accepted. Before submitting, please ensure that your signature is visible below.
Your Name
Your Name
Your Name