---------------Complete each item. Incomplete forms will not be processed. Type or print in black ink.
1. _______/_____/_______
----U.S. Social Security Number
--________________---__________
----LastName---------------Jr., III, etc.
__________________________________
--- First Name
--__________________________________
----Middle Name 		2. For which term, in which year, do you seek admission?
--August, 19____ --January, 19___ --May, 19___ --June, 19___
3. This application is for enrollment as:
__ First time in college Freshman
__ Undergraduate Transfer
__ Second Bachelors Degree
__ Former Degree student returning (no application fee required)
__ One-term enrollment only for transfer credit (Transient)
__ Other: _______________________________
4. If your transcripts, test scores, etc. might arrive under any name(s) other than those listed above, enter here: ______________________________ 5. Nation of Citizenship:---_______________________________ 6. __Male
__Female
7. Date of birth: _____/_____/_____ 8. Print your permanent address. All correspondence will be mail to this address.
---________________________________________________________________________
---Street Address ------------------------------------------------------------------------- Apt No.
---_____________________________________________________________________
---City -------------------- ------ Country (or Province) -------------------State/Nation
---_________________(_____)____________________(______)______________________
---Zip Code --------------Telephone Number ------------------Daytime Telephone Number
---(______)_________________________________________________________________
---Fax Number --------------------------------Email Address (if available)
9. Ethnic Origin, check one:
(Requested in compliance with Title VI of The Civil Rights Act of 1964).
---__ White (not of Hispanic origin)
-- __ Black (not of Hispanic origin)
---__ Hispanic
---__ Asian or Pacific Islander
---__ American Indian or Native Alaskan
10. If your native language is other than English, how many years have you spoken or studied English?
-----_______________________________
12. If you would like the appropriate campus organization notified, enter your religious preference:


---_____________________________		 11. In case of emergency, indicate the person you request the university to contact:
---________________________________________________________________________
---Last Name ---------------------------------First Name ---------------------------------M.I.
---________________________________________________________________________
---Street Address -------------------------------------------------------- ---------------- Apt No.
---________________________________________________________________________
---City --------------------------------- State/Nation---------------------------------ns-Zip Code
---(_____)___________________ (_____) ______________ ---Relatio
---Telephone Number -------------------Daytime Telephone Number-
---Relationship: __ Mother ---__Father -- __ Legal Guardian----- __ Other:______________
13. In which academic division do you wish to enroll?---------------------------------------------------------------- What is your planned major?
----(e.g., the College or School withing the university) ____________________________________ ---_____________________________
14. High School Graduation Date: ----------__________/__________ -------------------------_________________________________________
-------------------------------------------------------Month----------Year-------------------------High School Name (Official transcript must be provided)
-----High School Code: __________________________________ --------------------------_______________________ __________________
-----(Ask your counselor for the 6-digit CEEB Number) --------------------------------------------City ------------------------------------State/Nation
-----(_________)______________________________________ --------------------------If High School was completed by GED, enter year: 19____
------High School Area Code and Telephone Number -----------------(Official copy of test scores and official partial high school transcript required.)
15. An official transcript from each post secondary school you have attended must be provided.
You must list in chronological order every post-secondary institution (including dual enrollment) you have attended or will attend prior to entering this university if you attended previously. For multi-campus institutions, indicate the specific campus. Failure to list all institutions could result in your application being denied. Enter dates of attendance (including present enrollment) and degrees earned or expected before attending this university. Include Associate Degrees, certificates or diplomas. Enter credit earned or expected from each institution attended  
Use a separate sheet if necessary. Date of Attendance Degree/Date Credit Hours  
School Please do not abbreviate. City, State or Nation From --------To
Mo | Yr----|- Mo | Yr-		 Earned/Expected
Type --| -Mo -|- Yr		 Earned/Expected Number|UnitSem/Qtr.  
                     
                     
                     
                     
                     
16. Non-U.S. Citizens Only:
What VISA do you presently hold? __ F1 ----__ F2 ----__ J1 ----__ J2 ----__ None ----__ Other: _________ I-94 Expiration Date: Mo____/Yr____
What VISA are you applying for?---__ F1 ----__ F2 ----__ J1 ----__ J2 ----__ None ----__ Other: _________
Which institution issued your last I-20? __________________________________ Did you attend? __ Yes ----__ No
If a permanent immigrant, enter the alien registration number shown on you I-551 form: _______________________________
You must provide a photocopy of your Alien Registration card, front and back. ---------------------------------------------------------------------- Page 2

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