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Application for Undergraduate Admission

Use this form to apply for admission to the undergraduate program at VSU.
Fill out the form completely and submit it for printout and mailing with required $40.

1. Expected date of entrance
select one 
year		   2. Applying as

select one
3. Social Security Number (required)
(Please have your social security number when this application is submitted. If you do not have a social security number, you may apply for one at any post office.) Your application cannot be processed without a social security number unless you are an international student.
 
4. Name ,
last
first
middle
Jr., III, etc.
other names
5. Permanent Mailing Address
number, street and apartment number

city
state / province
zip / postal code
6. Phone Number
(area code) number		 7. Sex Female
Male
8. Birthdate
month/day/year 		a. Birthplace
city
state / province
9. Residence
  a. Are you a legal resident of Georgia? No Yes
b. If you are a Georgia resident, how long have you lived in Georgia?
c. If you are a Georgia resident, which county is your residence?
d. If not a Georgia resident, which state or country is your residence?

10. Citizenship country
a. If other than USA citizenship, Visa Status
Resident Alien? NO YES
I-20 Needed? NO YES

 11. Name and address of

name


address, if different from above
12. Last School Attended
13. Type of School Last Attended:
14. Do you plan to pursue a degree at VSU? Yes No
If yes, what major and degree do you plan to pursue?
15. Housing - Do you plan to live in a residence hall? Yes No
Freshmen under the age of 19, who live outside of commuting distance, are required to live on campus. (This does not constitute an application for housing. Appropriate forms for applying to live on campus will be sent when the student us accepted for admission.) 
16. Are you a veteran? Yes No a. Branch of Service
b. Dates of Service c. Date of Discharge
d. Type of Discharge e. Are you attending on the G.I. Bill?
Yes No
17. Race or Predominant Ethnic Background (optional)
White Black Hispanic American Indian
Asian or Pacific Islander Multiracial
18. Have you previously attended VSU? Yes No If Yes, when?
19. Have you previously applied to VSU? Yes No If Yes, when?

20. List all high schools, preparatory schools and colleges you have attended.
Include GED if applicable.
Name of School City & State Did You Graduate? Dates Attended
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

21. If you are a currently enrolled high school student, list your entire senior year schedule of classes below. The University System College Preparatory Curriculum is a factor in the admissions decision.

22. Are you presently attending a college or university? Yes No
a. If Yes, what was your date of entrance
b. and what will be your last date of attendance before attending VSU?
c. Do you plan to graduate from your present institution? Yes No
If yes, when?
23. Have you taken the SAT or ACT a. When?
b. If not, when do you plan to take it?

24. Have you ever been expelled or suspended from school for disciplinary reasons?
No Yes If so, attach a detailed explanation:

25. Have you ever been convicted of any criminal offense other than a traffic violation or are any criminal charges now pending against you?
No Yes
Convictions shall include: A finding of guilty by a judge or jury, a plea of guilty or a plea of nolo contendere.
If so, attach a detailed explanation.

26. Are you at this time eligible to return to all educational institutions you have previously attended?
Yes No If no, attach a detailed explanation:

27. I certify that the above statements are correct, and if accepted, I agree to abide by the regulations of Valdosta State University. I understand that any omission or misrepresentation of facts will automatically invalidate consideration of this application and/or dismissal from the University.
 
Yes No
mm/dd/yy


Optional section
1. It is my intention to take night classes only. Yes No

INFORMATION FOR CAMPUS ORGANIZATIONS
2. Religious affliation
3. As a student at Valdosta State University, my educational plans are to
A. graduate with a bachelor's degree
B. graduate with an associate degree
C. complete two years and transfer to another school
D. complete one year and transfer to another school
E. complete a second degree or take courses for certification
F. take only a few classes
G. I'm not sure what my plans will be.

E-Mail address: 
(Optional, if supplied copy of this application will be emailed for your additional copy.)


Last revised: 2/01/2000