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Legal History Explanation

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*
Date Format: MM slash DD slash YYYY
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 and 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)*
Date Format: MM slash DD slash 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 and 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)*
Date Format: MM slash DD slash 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.*
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.

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EQUAL OPPORTUNITY POLICY FOR STUDENTS Regent University does not discriminate on the basis of race, color, sex, national or ethnic origin, disability, age or veteran status in admissions, treatment or access to its programs and activities, or in the administration of educational policies, scholarships, loan programs, athletics or other University programs. In addition, Regent does not discriminate based on religion, except as necessary to comply with Regent’s Standard of Personal Conduct and Statement of Christian Community and Mission.

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