Kent State University Seniors to Sophomores APPLICATION CHECKLIST Thank you for your interest in the Seniors to Sophomores Program. Before submitting your application for admission to one of the Kent State University Columbiana County campuses, Kent State University at Salem or Kent State University at East Liverpool, you must consult with your high school guidance counselor before making plans to enroll in the S2S Program. If you decide the program is right for you, please be sure to submit all the required admission materials noted below. It is preferred that your high school guidance counselor submits all application materials together, however, materials may be sent in separately to the campus you wish to attend. Signed Seniors to Sophomores Application School Counselor Recommendation Form ACT or SAT scores should be noted on the counselor form along with the test date. Official High school transcripts Teacher Recommendation form A brief essay explaining why you are interested in the Seniors to Sophomores Program. If accepted, you will meet with a S2S Coordinator to schedule your college classes. If you would like to be considered to take a math class at Kent State University you will be invited to campus to take the ALEKS assessment before scheduling. It is STRONGLY recommended that you meet with your school guidance counselor and have your high school class schedule BEFORE you schedule your college classes. All required S2S Application materials above should be mailed to: SALEM CAMPUS or EAST LIVERPOOL CAMPUS Kristin Toothman, S2S Coordinator Kent State University at Salem 2491 State Route 45 South 400 East 4 th Street Salem, OH 44460 East Liverpool, OH 43920 (330)337-4226 (330)385-3805 ktoothma@kent.edu dbean3@kent.edu Donald Bean, S2S Coordinator Kent State University at East Liverpool
Please print clearly in ink. No admission fee required. KENT STATE UNIVERSITY Seniors to Sophomores Program Application for Admission Section 1 Full Name and Prior Attendance (circle your choice) I plan to enter Fall 20 Spring 20 Legal Last Name Middle Name Legal First Name Suffix (Sr., Jr., II, III, etc.) Have you previously applied to any campus of Kent State University? Yes No If yes, list the campus and year and term of previous application: Section 2 Permanent Address and Phone Permanent Street Address City State Zip Home Phone Cell Phone Have you lived at the above address for the last 12 consecutive months? Yes No If no, list all addresses during the last 12 months. Include both city and state. Section 3 Personal Information Are you a United States citizen? Yes No If no, and you are a permanent resident, provide your country of citizenship, permanent resident card number and date granted. Are you an Ohio resident? Yes No Email Address Social Security Number Gender: Male Female Ethnic Category: Not Hispanic or Latino Hispanic or Latino Ethnic information is used for reporting purposes only. Please select one or more as appropriate: African American (Black) American Indian or Alaskan Native Hispanic or Latino Caucasian American (White) Asian American or Pacific Islander American Non-U.S. Citizen Birth date Month Day Year Have you ever been convicted of a criminal offense or have charges pending against you at this time? (other than minor traffic violations) Yes No Have you ever been dismissed, suspended or placed on probation by any other college or university for a non-academic reason? Yes No Page 1 of 2 (see back)
Section 4 High School Information High School Name High School City Expected Graduation or GED Date Month Year Have you taken the ACT or SAT? Yes No Month/Year of most recent test Are you scheduled to take the ACT or SAT in the future? Yes No If yes, when? While in high school, have you participated in a Post-Secondary Enrollment Option program, Dual Credit program, or taken college courses for credit? If yes, you must complete Section 6 - Previous College Information. Yes No Section 5 Previous College Information Complete only if you have any previous college attendance. You must submit official college transcripts from any institution listed. Name of Institution City/State From/To (Month/Year) Degree Obtained (if any) Section 6 Permission Required Notifications & Financial Responsibility Acknowledgement The purposes of this section are (1) to give the University permission to release information required by the law to notify the parent/guardian, school district and State Superintendent of Public Instruction about admission, course enrollment, failure to complete course(s) and grades earned; and (2) to establish the responsibility of payment to your school system in the event that a student withdrawals after the 100% refund period or fails to complete course/courses being taken under the Seniors to Sophomores Program. I give Kent State University permission to: send any grades I receive in this program to my school district; notify me, my school district and the State Superintendent of Public Instruction of my acceptance into the Post-Secondary Enrollment Options Program; Notify me, my school district and the State Superintendent of Public Instruction of my course registration(s) under this program; and notify me, my parent/guardian, my school district and the State Superintendent of Public Instruction if I fail to complete one or more courses as a result of a formal withdrawal process or if I fail to attend classes regularly that are taken under this program. In addition, I understand if I fail to complete the course(s) whether through the withdraw/exit process on from nonattendance, I will be responsible to my school district for tuition, fees, books and materials that would be charges a regular undergraduate students. By my signature I attest to the fact that I have read and understand the above and that all information given on this application is complete and correct. I also understand that any intentional omission or falsification will result in denial of admission or immediate dismissal. Applicants and Parents/Guardians Must Sign Here! Applicant s Signature Date Parent or Guardian s Signature Date Office Use Only Official High School Transcript Received ACT or SAT Scores Received Date Admitted in Banner Processor
KENT STATE UNIVERSITY S2S Guidance Counselor Recommendation and Official High School Transcript Request NOTE: This section to be completed by the Applicant and Parent first: Applicant s Name Last Name First Name M.I. Under the provisions of the Family Educational Rights and Privacy Act, the applicant for Kent State University s Senior to Sophomore Program has the right to retain or waive access to references provided by high school teachers and administrators. Access will be granted to the student/parent unless this waiver is signed by the student and parent/guardian. I hereby waive the right to review references provided by high school teachers and administrators for Kent State University s Senior to Sophomore Program and officially request my high school Guidance Counselor to forward my official high school transcripts and ACT scores to Kent State University at Salem. Applicant s Signature Date Parent or Guardian s Signature Date After completing the above information, deliver this form to your high school counselor. Your counselor will complete the following section and return this form and an official high school transcript to Kent State University Salem. This section to be completed by the High School Counselor: Please respond to the following questions: 1. Student s numerical rank in high school class (e.g., 4 in 195 ): in. 2. Student s grade point average in high school: on a scale. 3. Student s ACT/SAT scores: Check here if scores are not available English Mathematics Reading Science Composite Use/Mech Rhet ElAlg /AlgGeo/GeoTrig SocSci ArtsLit Please complete this section by rating the following statements: 0 = LOW 5 = HIGH Student s social maturity: 0 1 2 3 4 5 Student s ability to study independently: 0 1 2 3 4 5 Do you recommend this student for Kent State Salem s Seniors to Sophomores Program? Yes No Comments: (use back if desired) Counselor s Signature Date Print or Type Name Title NOTE! Please mail this form along with the applicant s ACT scores and official high school transcript to: SALEM CAMPUS EAST LIVERPOOL CAMPUS Kristin Toothman or Donald Bean Seniors to Sophomores Coordinator Seniors to Sophomores Coordinator Kent State University Salem Kent State University East Liverpool 2491 S.R. 45 S., Salem, OH 44460 400 East 4 th Street, East Liverpool, OH
Kent State University Seniors to Sophomores Teacher Recommendation Form Applicant Last Name First Middle Social Security Number - - Campus attending: (Salem or East Liverpool) Under the provisions of the Family Educational Rights and Privacy Act, the applicant for the Seniors to Sophomores Program has the right to retain or waive access to references provided by high school teachers and administrators. Access will be granted to the student/parent unless student and parent/guardian sign this waiver. I hereby waive the right to have access to references provided by high school teachers and administrators for Kent State University s Seniors to Sophomores Program. Signature of Student High School Student: Signature of Parent/Guardian After completing the top of this form, deliver it to one of your teachers. They will complete the following and return it to the school counselor or the Kent State Columbiana County campus you wish to attend (Salem or East Liverpool) as noted above. Teacher: Please complete the remainder of this form using 1 = LOW to 5 = HIGH Date: Academic readiness for college level coursework: 1 2 3 4 5 Student s social maturity and interaction in college: 1 2 3 4 5 Student s ability to study independently: 1 2 3 4 5 Do you recommend this student for the Seniors to Sophomores Program? YES NO COMMENTS: Signature Print Name Title Please forward to your high school counselor or mail completed Teacher Recommendation form to the campus the student wishes to attend as noted above: SALEM CAMPUS OR EAST LIVERPOOL CAMPUS Kristin Toothman, S2S Coordinator Donald Bean, S2S Coordinator Kent State University at Salem Kent State University at East Liverpool 2491 State Route 45 South, Salem, OH 44460 400 East 4 th Street, East Liverpool, OH 43920