Application for Undergraduate Admission

Transcription

1 1 U Attach The California State University Application for Undergraduate Admission $55 (U.S.) application fee payable to The California State University. The fee is nonrefundable and may not be transferred to another term. Please print responses in black ink. Response to each item is mandatory unless otherwise indicated. Attach check or money order here. 1. This is an application for admission to Summer Quarter or Semester 2001 Fall Quarter or Semester 2001 Winter Quarter (or term) January 2002 Spring Quarter or Semester Social Security Number 3. If you have previously applied to or attended this campus, please list: of application 4. Legal name Year Name of Campus Last term attended Check one term only and send to the campus listed. Main Campus Off-Campus Center Last name Suffix (e.g., Jr., Sr.) Year First name 5. Other name(s) that may appear on your academic records Middle name Last name First name Middle name 6a. Current mailing address Street number Street name Apartment Country, if not USA City State Zip Code International Postal Code - 6b. Permanent address if different from current address Street number Street name Apartment City State Zip Code - 7a. Home telephone 7b. FAX Area Code Number Area Code Number 7c. Daytime phone or message # 7d. Area Code Number D D 8. Birthdate 9. Sex Male Female Month Day Year 10a. Name of intended major Major code See majors section, pages Emphasis/concentration (if any) 10b. Alternate major (optional) Alternate major code Accommodation status Enrollment status Continued on next page

2 11. How many total college transferable semester units will you 12. What is your degree objective? have completed at time of entry/reentry in CSU? Enter code in box: Enter code in box: (Include units in progress and planned.) 0 No units completed semester units 0 None 4 Other bachelor s (BM, BFA, BVEd, etc.) 1 Fewer than 30 semester units 4 90 or more semester units 2 BA 9 Other (specify): semester units 5 Have bachelor s degree or equivalent. 3 BS 13. If your major and/or first choice campus is closed and you wish to have your application redirected where possible to another CSU campus, list that campus (optional). 14a. Do you wish to apply or reapply through the Educational Opportunity Program? (Please read page 7 of the booklet before answering yes.) Yes No If you answered yes to question 14a please answer questions 14b, 14c and 14d: 14b estimated family income $ Semester units = quarter units x 2/3 Your Name: 2000 family size 14c. Do you live with: one parent both parents legal guardian independently 14d. If you have previously enrolled in any EOP/EOP&S program, list campus: EOP CSU 15. Teacher or other credential program. Enter appropriate code (N or X) in box: EOP&S Community College N Not interested in a credential program X Interested in a credential program now or at a future date Credential objective name Credential Code (see page 18) 16. Permanent residence. If you live in California, list county of residence. If you live outside of California, list other U.S. state or country. 17. Country of citizenship (all must answer). 18a. Enter your citizenship code in box (all must answer). Y U.S. citizen I Immigrant I-551 ( green card ) Date issued: D D Month Day Year O Other visa (specify) Date issued: 18b. If you were born outside the U.S., what year did you move to the U.S.? 19. Enter your ethnic identity code in box (optional). D D Month Day Year (You must provide the date issued and be prepared to submit verification.) R Refugee/Asylum F F visa (student) J J visa N None of the above 1 American Indian or Alaskan native; tribe 2 Black, non-hispanic, including African American C Chinese V Vietnamese 7 White 3 Mexican American, Mexican, Chicano J Japanese T Thai F Filipino A Central American K Korean S Other Southeast Asian 8 Other B South American R Asian Indian G Guamanian 9 No response Q Cuban 5 Other Asian H Hawaiian D Decline to state P Puerto Rican M Cambodian N Samoan 4 Other Latino, Spanish-origin, Hispanic L Laotian 6 Other Pacific Islander 20. If you have been on active duty in the U.S. military services, enter a Y in box. Attach a copy of DD214 or DD295 for evaluation of credit. 21. High school attended City and State Graduation Date City State GED Date Month Year Month Year Permanent residence Country of citizenship H.S. code

3 22. High school grade point average for all work completed after the 9th grade, not counting military science and physical education: GPA. Total grade points A = 4, B = 3, C = 2, D = 1, F = 0 GPA = Total units (plus 1 for each junior and senior honors course with C or better, up to a maximum of 8 extra points) 23. Enter test scores and dates or date you will take the test. ACT Scores Date(s) TOEFL Score Date(s) E M R S Composite TOEFL w/essay SAT I Scores Date(s) Date(s) Score V M Total 24. All transferable undergraduate college work: 25. Are you eligible to re-enroll at all institutions previously attended? Yes No GPA. If not, attach an explanation and name any institution you are ineligible to re-enter. 26. Print the names and locations of all colleges and universities attended, even if no coursework was completed. Begin with the last institution attended. Attach a separate sheet if you need more space. For units in progress and planned, see item 28. All Institutions School Name A N Y C O L L E G E State C A From Mo. Enrolled Yr. Mo. To Yr. Number of Transferable Units Completed Sem. Units Qtr. Units Degree Received Year Degree To Be Received Year Fee Status Resident /Non* * Attach evidence of nonresident status. Total 27. List below college courses in which you are currently enrolled and additional courses you plan to complete (including summer school) before entering CSU. Attach a separate sheet if more space is needed. Courses in Progress/Planned A Institution (FA/WT/SP/SU) Year N Y C O L L E G E F A E N G L A Dept. Course No. and Title 1 C O M P Total Units in Progress Unit Value 3 Other electives: CC transfer Degree held Institution of origin Transfer units in progress.

4 28. High School Preparation (all first-time freshman applicants and all applicants with fewer than 56 transferable semester units). Enter all college preparatory courses in the appropriate section. If course has been completed, enter the grade earned; if in progress, enter I instead of grade. List only courses that can be verified by your final transcript. List college preparatory elective courses in applicable subject area (e.g., fourth year of college preparatory mathematics in mathematics section). If you are listing courses taken at a community college or at a high school other than the one you will graduate from, please write its name next to those courses. College Preparatory Subjects English 4 years Composition and literature and other English courses designated as college preparatory. Grade Level Taken 9 Example: English 9A/9B Title of Courses Completed, in Progress, or Planned Semester/Summer Grade Fall Spring Summer A B Total English Units Mathematics 3 years Algebra, geometry, intermediate algebra, and other advanced mathematics. Courses taken in 7th and 8th grades may be considered. Do not include pre-algebra. Total Mathematics Units U.S. History/Government 1 year One year of U.S. history or 1/2 year of U.S. history and 1/2 year of civics or American government. Total U.S. History/Government Units Laboratory Science 1 year with laboratory. Biology, chemistry, physics, etc. Total Laboratory Science Units Foreign Language 2 years in the same language. Subject to waiver for applicants demonstrating equivalent competence. Total Foreign Language Units Visual and Performing Arts 1 year Art, dance, drama, music. College Preparatory Electives up to 3 years Courses not listed above. Agriculture, social science (e.g., world history, cultures, geography, economics, and psychology). World History, Cultures and Geography: Other Electives: Total Visual/Performing Arts Units Total College Preparatory Elective Units

5 5 Your Name: Application for Undergraduate Admission 29. For transfers, please list courses completed or in progress that meet the CSU General Education requirements or IGETC requirements in Oral Communication, Written Communication, Critical Thinking, and Mathematics/Quantitative Reasoning. (California Community Colleges usually designate CSU General Education requirements as A1 Oral Communication, A2 Written Communication, A3 Critical Thinking, and B4 Mathematics/Quantitative Reasoning or IGETC (1A,1B, 1C, 2). This self-reported information will be verified. Failure to complete GE coursework with minimum C grades as planned or reported could jeopardize offers of admission. Oral Communication Written Communication Critical Thinking Math/Quant. Reasoning Total number of GE/IGETC units completed Institution In progress or planned (FA/WT/SP/SU/) Year Dept. Course No. and Title Unit Value *GRADE * If in progress or planned, use I Your responses to the following questions are required to make a preliminary assessment of your residency status for admission and tuition purposes. The campus may request additional information prior to making a final residence determination. 30. List places you lived before your present stay in California began, and the parent/guardian with whom you resided. From Date To Date State or Country Parent/Guardian 31. Please check one of the following: a. If you will be younger than 19 years of age on the residence determination date (see page 8), check here and answer items as they pertain to the parent or legal guardian with whom you most recently resided. b. If you will be 19 years of age or older on the residence determination date (see page 8), check here and answer items as they pertain to you. 32. If you are answering items as they pertain to your parent or legal guardian, please indicate the citizenship status of your parent or guardian by checking one of the following: Y U.S. citizen I Immigrant I-551 ( green card ) Date issued: D D D D O Other visa (specify) Date issued: N None of the above 33. What state do you regard as your permanent home? 34. Do you claim California residency? Yes No If no, proceed to # If you claim California residency, when did your present stay begin? 35a. Birthplace 36. Have you lived in California continuously since birth? Yes No If your response to #36 was yes, proceed to #44. If no, answer questions Are you claimed as a dependent on the military record of any member of the U.S. armed forces? Yes No If yes, answer #40 for the service person. 38. Possess driver s license? Yes No If yes, give state, date of issuance and license number Possess a DMV identification card? Yes No If yes, give state, date of issuance and ID number 39. Ever registered to vote? Yes No D D If yes, give state in which you last registered to vote, date registered, and date last voted. State Date License No. State Date Registered Date Last Voted 40. Member or veteran of U.S. armed forces? Yes No Date joined From what state State Date ID No. D D D D D D D D Date separated from active duty, if any D D 41. State and current registration of all motor vehicles owned State D D D D Date Registered State Date Registered 42. Last three state income tax returns filed on total income and year covered by each State Year State Year State Year 43. Employed in California in the past year? Yes No Employer D D D D From To

6 44. Do you have the interest and ability to participate in NCAA-sanctioned intercollegiate athletics competition (optional)? Yes Sport If yes, you may contact the campus Department of Athletics to register your interest in a sport or sports. No 45. Gross annual income and family size (optional). Under federal regulations, you are considered a dependent student if you are under 24 years unless you are a graduate student; are married or have dependents other than a spouse; are an orphan/ward of the court; or are a veteran of the U.S. armed services. If dependent, estimate parents 2000 gross annual income and enter code in box, and indicate family size including your parents, yourself, and other dependents. If independent, estimate your income and spouse s income if married and enter code in box, and indicate your family size including yourself, spouse, and other dependents. Dependent Students Only: Estimated Gross Annual Income (enter code in box): Family Size 1 Less than $24,000 3 $36,000 to $47,999 5 $60,000 to $71,999 7 I cannot estimate my parents income 2 $24,000 to $35,999 4 $48,000 to $59,999 6 $72,000 or more Independent Students Only: Estimated Gross Annual Income (enter code in box): Family Size 1 Less than $6,000 3 $12,000 to $23,999 5 $36,000 to $47,999 7 $60,000 or more 2 $6,000 to $11,999 4 $24,000 to $35,999 6 $48,000 to $59,999 8 I cannot estimate my income 46. What are your parents highest levels of formal education? (optional) Enter code in box for: Mother and Father 1 No High School 3 High School Graduate 5 2-Year College Graduate 7 Postgraduate 2 Some High School 4 Some College 6 4-Year College Graduate 47. CERTIFICATION to be read and signed by all applicants to certify the accuracy of the information provided. I certify under penalty of perjury, that I have provided complete and accurate responses to the items on this application. I further certify all official documents submitted in support of this application are authentic and unaltered records that pertain to me. I authorize release of any information submitted by me in connection with my application to any person, firm, corporation, association, or government agency, but only to verify or explain the information, obtain pertinent records, or in connection with perjury proceedings. My signature certifies the accuracy and completeness of the information provided. I understand that any misrepresentation may be cause for denial or cancellation of admission or enrollment. I certify that so long as I am a student at this institution, I will advise the residence clerk if there is a change in any of the facts affecting my residence. Signed at City and County Applicant s Signature Date When claiming California residence and completing this form outside California, it must be subscribed and sworn to before a person authorized to administer oaths, such as a notary public. Fee Refund Policy Fees may be refunded only as authorized by Sections 41802, 41803, and of Title 5, California Code of Regulations. Details concerning the fees that may be refunded, the circumstances under which they may be refunded, and the appropriate procedure to be followed in seeking a refund may be obtained from the office of admission and records on each campus. Use of the Social Security Number You are required to include your social security number (or taxpayer identification number) on admission application forms to all CSU campuses pursuant to Section 41201, Title 5, Code of California Regulations and Section 6109 of the Internal Revenue Code. CSU campuses use the social security number to identify your student records maintained in your association with the campus and, if needed, to help collect debts owed the university. Your social security number may be written on your application fee check to facilitate the processing of your fee payment. Also, the Internal Revenue Service requires the university to file information returns that include the student s social security number and other information such as the amount paid for qualified tuition, related expenses, and interest on educational loans. That information is used to help determine whether you, or a person claiming you as a dependent, may take a credit or deduction to reduce federal income taxes. If you do not have a social security number at the time you file the application, you may leave the item blank and the campus will assign a temporary number. However, you are required to obtain a social security number and submit it to the university by the time you begin enrollment. Failure to furnish your correct social security number may result in the imposition of a penalty by the Internal Revenue Service. Received For Office Use Only Date Fee Status Data Entry Date Previous Student File No. By By