2011-12 TRANSFEr Application

For Spring 2012 or Fall 2012 Enrollment

APPLICANT

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Preferred name, if not first name (only one) ____________________________ Birth Date ____________________________________________________ p Female p Male

mm/dd/yyyy

Former last name(s) _____________________________________________US Social Security Number, if any ___________________________________

Required for US Citizens and Permanent Residents applying for financial aid via FAFSA

Area/Country/City Code

Preferred Telephone p Home p Cell Home (_______) __________________________________ Cell (_______) __________________________________

Area/Country/City Code

E-mail Address ________________________________________________

Number & Street

IM Address ____________________________________________________

Apartment #

Permanent home address ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

City/Town

County or Parish

State/Province

Country

ZIP/Postal Code

If different from above, please give your current mailing address for all admission correspondence. (from ___________ to ___________)

Number & Street

(mm/dd/yyyy) (mm/dd/yyyy)Apartment #

Current mailing address ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

City/Town

County or Parish

State/Province

Country

ZIP/Postal Code

If your current mailing address is a college or university, include name of school here: _________________________________________________________________

FUTURE PLANS

Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants.

College ________________________________________________________

Deadline ______________________________________________________

mm/dd/yyyy

Entry Term: p Fall (Jul-Dec) p Spring (Jan-Jun)

Academic Interests _____________________________________________________________________________________________________________________________________________________________________Career Interest _________________________________________________

Do you intend to apply for need-based financial aid? Do you intend to apply for merit-based scholarships? Do you intend to be a full-time student?

Do you intend to enroll in a degree program your first year? p Yes p Nop Yes p Nop Yes p Nop Yes p No

Do you intend to live in college housing? ______________________________What is the highest degree you intend to earn? _________________________

DEmogRAPhICS

Citizenship Status ______________________________________________Non-US Citizenship ________________________________________________________________________________________________________________________________________________________________________Birthplace ________________________________________________________

City/Town State/Province Country

1. Are you Hispanic/Latino?

p Yes, Hispanic or Latino (including Spain) p No If yes, please describe your background.

____________________________________________________________2. Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more and describe your background.)

p American Indian or Alaska Native (including all Original Peoples of the Americas)

Are you Enrolled? p Yes p No If yes, please enter Tribal Enrollment Number________________

Years lived in the US? ____________ Years lived outside the US? __________ __Language Proficiency (Check all that apply.)

S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)

S R W F H

____________________________________________________________p Asian (including Indian subcontinent and Philippines)

____________________________________________________________p Black or African American (including Africa and Caribbean)

____________________________________________________________p Native Hawaiian or Other Pacific Islander (Original Peoples)

____________________________________________________________p White (including Middle Eastern)

___________________________________________________________

_______________________________________________ p p p p p_______________________________________________ p p p p p_______________________________________________ p p p p pOptional The items with a gray background are optional. No information you provide will be used in a discriminatory manner.

Religious Preference _______________________________________________US Armed Services veteran status _____________________________________