TRANSFER APPLICATION PACIFIC LUTHERAN UNIVERSITY BIOGRAPHICAL INFORMATION Full Legal Name: FIRST MIDDLE LAST Preferred First Name: Social Security Number: Gender: q Male q Female q Other Former Name: APPLICATION INFORMATION For Admission to: Please indicate your educational objective at PLU: q First bachelor s degree q Second bachelor s degree Have you visited the PLU campus? q Yes q No When? / / What influenced you to apply to PLU? ADDRESS Permanent Address: CITY STATE ZIP COUNTRY PHONE CELL PHONE Mailing Address: CITY STATE ZIP COUNTRY PHONE CELL PHONE TRANSFER APPLICATION 1
ADDITIONAL INFORMATION Email: Parent/Family Email: Birthdate: / / Birthplace: Country of Citizenship: Are you a U.S. permanent resident? q Yes q No Visa Type/Classification: Other: FINANCIAL AID Do you plan to submit a FAFSA? q Yes q No SCHOLARSHIPS Please indicate any of the following artistic achievement scholarships for which you plan to audition/apply: q Art q Dance q Forensics/Debate q Music q Theatre Do you plan to apply for the Provost Scholarship? q Yes q No FAMILY INFORMATION (Parent/Legal Guardian 1) q Mr. q Mrs. q Miss FIRST MIDDLE LAST Relationship: Birthday: / / Mailing Address (if different): CITY STATE ZIP COUNTRY PHONE CELL PHONE Email: Occupation: Job Title: Business/Organization/Employer: Colleges Attended College Degree Earned: Year: College Degree Earned: Year: TRANSFER APPLICATION 2
(Parent/Legal Guardian 2) q Mr. q Mrs. q Miss FIRST MIDDLE LAST Relationship: Birthday: / / Mailing Address (if different): CITY STATE ZIP COUNTRY PHONE CELL PHONE Email: Occupation: Job Title: Business/Organization/Employer: Colleges Attended College Degree Earned: Year: College Degree Earned: Year: Did either of your parents graduate from a two-year college? q Yes q No Did either of your parents graduate from a four-year college? q Yes q No Did either of your parents attend PLU for two or more consecutive semesters? q Yes q No Please list their student name(s) and graduation year: NAME GRADUATION YEAR NAME GRADUATION YEAR Have you been or are you currently a foster youth in the state of Washington? q Yes q No Have you been in foster care in Washington State for at least one year since your sixteenth birthday and emancipated from care on or after January 1, 2007? q Yes q No TRANSFER APPLICATION 3
Siblings: Relatives/Friends who attended PLU: TRANSFER APPLICATION 4
EDUCATIONAL BACKGROUND High School: q Public q Private q Home School Graduation Date: / GED taken: / SAT score: ACT score: Are you a member of Phi Theta Kappa? q Yes q No Are you a member of American Honors? q Yes q No Are you a College Bound Scholar? q Yes q No Do you expect to earn a degree prior to enrolling at PLU? q Yes q No What type of degree?: q DTA (Direct Transfer Agreement - Washington) q AAOT (Associate of Arts Oregon Transfer Degree) q IGETC (Intersegmental General Education Transfer Curriculum California) q AA q AAS-T q Other: All college(s)/universities in order of attendance: If still enrolled in a college, indicate anticipated leaving date: / MONTH YEAR INSTITUTION CITY STATE Dates Attended: / to / Degree: Date Complete / INSTITUTION CITY STATE Dates Attended: / to / Degree: Date Complete / INSTITUTION CITY STATE Dates Attended: / to / Degree: Date Complete / INSTITUTION CITY STATE Dates Attended: / to / Degree: Date Complete / TRANSFER APPLICATION 5
EDUCATIONAL PLANS Intended major: Other subjects/career area interests: Do you plan to live on-campus? q Yes q No Are you a veteran of any branch of the U.S. Armed Forces? q Yes q No If yes, which branch?. Are you currently serving in any branch of the U.S. Armed Forces? q Yes q No If yes, which branch?. Are you a dependent spouse of a veteran or someone currently serving in the military? q Yes q No If yes, which branch?. Are you a dependent (child) of a veteran or dependent of someone currently serving in the military? q Yes q No If yes, which branch?. Please indicate if you are applying to PLU through any of the following programs: q Army AAMED q Army ROTC q Navy MECP q Army Green to Gold Are you a dependent of a veteran or someone currently serving in any branch of the U.S. Armed Forces? q Yes q No Please indicate if you will be applying for the Army ROTC scholarship: q Yes q No Please indicate if you plan to use the following benefits: q Post-9/11 G.I. Bill Yellow Ribbon q Vocational Rehabilitation To what other colleges/universities do you plan to apply for admission? RELIGIOUS/ETHNIC INFORMATION Are you Hispanic or Latino? q Yes q No Select one or more from the following: (checkboxes for the following) q American Indian or Alaska Native q Asian q Black or African American q Native Hawaiian or Other Pacific Islander q White If other than English, what primary language is spoken in your home? Religious Preference q Lutheran Home Congregation City Synod q Baptist q Episcopal q Jewish q Methodist q Presbyterian q Roman Catholic q Other Christian q Buddhist q Muslim q Hindu q None q Choose Not to Report Other: Are you a child of clergy? q Yes q No TRANSFER APPLICATION 6
ACTIVITIES, LEADERSHIP AND HONORS RESUME 1. List your significant school and community activities and awards, and any activities you plan to continue at PLU. 2. Describe any special circumstances you believe should be considered in connection with this application. TRANSFER APPLICATION 7
CURRENT YEAR ACADEMIC INFORMATION Courses to be completed during the year: Semester 1/Trimester 1 Semester 2/Trimester 2 Semester 2/Trimester 2 STATEMENT OF CHARACTER AND SIGNATURE Have you been convicted of a felony or gross misdemeanor, or do you have a court case pending against you at this time? Yes No By submitting this application for enrollment to Pacific Lutheran University, I hereby certify that the information contained in it is true and complete to the best of my knowledge and belief. I understand and agree that if PLU discovers at any time during my enrollment that I have provided inaccurate or untruthful information in my application (or any related documents), PLU may immediately terminate my enrollment and/or housing without reimbursement or refund to me of any costs, tuition, fees or rent. Permission is hereby given to release appropriate test scores and academic records requested by Pacific Lutheran University. I agree / / NAME OF APPLICANT (PRINT) SIGNATURE OF APPLICANT DATE PLU does not discriminate on the basis of race, color, national origin, sex, sexual orientation, disability or age in its programs and activities. The following person has been designated to handle inquiries regarding non-discrimination policies: Title IX Coordinator, PLU Human Resources, Tacoma, WA 98447; 253.535.7187. TRANSFER APPLICATION 8