EmailMe Form - College Application

Name

First Last

Email

Phone

Social Security Number

Address

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

Emergency Contact

Name

First Last

Relationship

Phone

Email

Address

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

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Nation of Citizenship

Race / National Origin

Native Language

Religion

Gender

Male

Female

Are you a veteran of the U.S. Military?

Yes

No

Date of Birth

MM / DD / YYYY

This application is for enrollment as:

Freshman (First time in College)

Undergraduate Transfer

2nd Bachelor's Degree

Former Student Returning (FSR)

What is your planned major?

For which campus do you seek admission?

For which term do you seek admission?

Please indicate your housing preference:

On-campus

Off-campus

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution?

Yes

No

If yes, please explain.

Have you ever been 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 (including traffic violations which resulted in a fine of $200 or more?)

Yes

No

If yes, please explain.

High School Information

High School Name

6 Digit High School CEEB Code

Graduation Date

MM / DD / YYYY

Or enter year of GED