GO WEST. Undergraduate Application for Admission AMAZING THINGS HAPPEN WHEN YOU

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1 Undergraduate Application for Admission AMAZING THINGS HAPPEN WHEN YOU GO WEST. Check admission requirements, required documents, deadline dates and application status at

2 This application should not be submitted if you previously attended UWG as a freshman or transfer student. Please complete our readmission application. Please complete this application and return with $40 application fee to: Office of Admissions Mandeville Hall Front Campus Drive University of West Georgia Carrollton, Georgia All new students attending regularly scheduled classes or receiving resident credit will be required to submit a Certificate of Immunization prior to attending classes. NOTE: All immunization documentation must be recorded and submitted on a UWG Certificate of Immunization form! Immunization and Health forms can be found at: Immunization Requirements $40 NONREFUNDABLE APPLICATION FEE Required for all applicants Application and Document Deadlines Fall Semester...June 1 Spring Semester... v. 15 Summer Semester... May 15 Although these are our final application and document deadlines, we recommend that you apply early. Please mail completed immunization form to: Office of Student Health Services University of West Georgia Carrollton, Georgia UWG complies with the provisions of Title IX, which prohibits discrimination on the basis of sex. Inquiries may be addressed to the UWG Title IX Coordinator at 1601 Maple Street, Carrollton, GA 30118, , or to the U.S. Department of Education s Civil Rights Hotline, NAME AND ADDRESS You must complete all sections of this application in order to be considered for admission. Social Security Number First Name Middle Name Last Name Preferred Name Former Last Name Address Apt. Number City Home Phone Cell Phone State Zip County Work Phone UWG occasionally sends information tailored to the interest of parents. If you would like for your family members to receive info from the University of West Georgia, please provide a name and address here: First Name Last Name EMERGENCY CONTACT INFORMATION Emergency Contact First Name Emergency Contact Last Name Relationship Emergency Contact Phone DEMOGRAPHIC INFORMATION Gender: EthnicRacial Group (optional): Male Date of Birth: Female Are you HispanicLatino? What is your race? Select one or more: American Indian or Asian Alaska Native Black or African American Native Hawaiian or Pacific Islander White

3 CITIZENSHIP INFORMATION If you are a U.S. citizen: By Birth State of Birth Naturalized Citizen Date of Naturalization Country of Birth If you are a nonu.s. citizen: Current Status: Permanent Resident Alien (submit a copy of your card) Country of Birth Applicant for Permanent Resident Alien Refugee Country of Citizenship Political Asylum Exchange Visa Student Visa (F1 or J1) Other Native Language 120 Certificate of Eligibility Needed: (onlineonly students are not elibgible) Probable semester entry to UWG: Fall (Begins in August) Spring (Begins in January) Summer (Begins in MayJune) Year ADMISSION INFORMATION Program of studyintended major: Major Code See listing of majors on back. If you are not sure, list Are you planning to take courses: On Campus Off Campus If off campus, which location: Newnan Dalton Rome ecore online courses only Douglasville Do you plan to live on campus: Are any members of your family alumni of UWG? Father Mother BrotherSister AuntUncle Other Admission category (Check only one): Freshman ( previous college work) Joint EnrollmentDual EnrollmentAccel Senior Enrichment Gifted Junior Transfer (Previous attendance at another postsecondary institution) Transient (Visiting student from another accredited institution) Advanced Academy of Georgia (Also complete Academy supplementary application) HIGH SCHOOL INFORMATION Senior Citizen (age 62 or older; maximum 12 hours of enrollment) Seeking second degree ndegree seeking Auditor (t seeking course credit) PostBaccalaureate (Hold a Bachelor s degree) Seeking second degree ndegree seeking Home Schooled Last High School Attended ( abbreviations) From: City State To: Did You Graduate? If yes, date of graduation If no, anticipated month and year of graduation. Completion Date (MMYYYY) Earned GED Completion Date (MMYYYY) Have you taken the SAT or ACT? Test date (SAT): SAT Critical Reading Score SAT Math Score Test date (ACT): ACT English Score ACT Math Score ACT Composite Future Test Dates: SAT ACT Future Test Dates: SAT ACT COLLEGE INFORMATION List all colleges you have attended (beginning with the last college attended). This must include any institution at which you registered for classes (even if a withdrawal was granted), and those which you will attend prior to enrollment at UWG. Attach additional postsecondary work as needed. Joint enrollment work should be included here. BY UNIVERSITY SYSTEM POLICY, STUDENTS MAY NOT CHOOSE TO EXCLUDE WORK ATTEMPTED AT ANOTHER INSTITUTION. FAILURE TO LIST PRIOR COURSEWORK CAN RESULT IN THE REJECTION OR DISMISSAL OF THE APPLICANT. Please attach a sheet with additional colleges attended as needed. Attended from Attended to Are You Currently Name of Institution City State (MY) (MY) Attending? # of Hrs. Degree THE BEST AND BRIGHTEST GO WEST.

4 OTHER INFORMATION The University of West Georgia is committed to maintaining a safe environment for all members of our community. All applicants must answer these questions. Your application will not be processed without these responses. An affirmative answer to any of these questions does not automatically prevent admission to the institution but does require review. Please write here or attach a brief explanation for each instance you answer. The statement will be used in the review process. Have you ever been convicted of a crime other than a minor traffic violation? If yes, explain in 100 words or less. Are there any criminal charges currently pending against you? If yes, explain in 100 words or less. Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere, an Alford plea to a criminal charge or a plea under a first offender act? If yes, explain in 100 words or less. Do you currently have disciplinary or academic misconduct charges pending against you from a high school, college or university? If yes, explain in 100 words or less. Have you ever been disciplined, suspended or expelled for conduct code violations from a high school or a postsecondary educational institution? If yes, explain in 100 words or less. RESIDENCY INFORMATION Applicants who do not provide complete information will be charged the outofstate tuition rate. TUITION CLASSIFICATION SECTION 1 You must answer ALL these questions about YOURSELF. 1. Are you applying for instate tuition? (If you answer no, you will be classified as outofstate) In accordance with Board of Regents Policy 4.3.4, all applicants who are accepted for admission or readmission to the University of West Georgia for Fall 2011, or any academic semester thereafter, and who seek to be classified as instate for tuition purposes, will be required to provide validation of residency and lawful presence in both the United States and Georgia. For the validation purposes above, one of the following documents must be submitted: FAFSA (Free Application for Federal Student Aid) OR Certified U.S. Birth Certificate (no photocopies) U.S. Certificate of Naturalization (USCIS form N550 or N570) GA Driver s License (issued after ) GA ID Card (issued after ) Current U.S. Passport Current Military ID (not dependent) U.S. Certificate of Citizenship (USCIS form N560 or N561) U.S. Certificate of Birth Abroad issue by Dept. of State (DS1350) Consular Report of Birth Abroad (FS240) Current, valid Permanent Resident Card 2. Have you ever lived outside the state of Georgia at any time in your life (including being born in another country)? 3. If you have lived outside the state of Georgia (including being born in another country), how long have you continuously resided in Georgia after returning to the state? Years Months 4. If you moved here less than two (2) years ago, what was your reason for relocating to Georgia? 5. List employment for the previous two (2) years. Provide complete information (attach sheet if necessary). From (MoYr) To (MoYr) Employer CityState FullParttime Continue on back

5 TUITION CLASSIFICATION SECTION 2 You must answer ALL these questions about YOURSELF. 1. DRIVERS LICENSE: A. Do you have a driver s license or stateissued ID? B. If YES, was it issued in Georgia? If NOT from Georgia, which state: 2. MOTOR VEHICLE: A. Do you own a motor vehicle? B. If YES, is it registered in Georgia? If NOT in Georgia, which state: 3. VOTER REGISTRATION: A. Are you registered to vote? B. If YES, are you registered in Georgia? If NOT in Georgia, which state: 4. STATE TAXES: A. Did you file a state income tax return in the past year? B. If YES, did you file a Georgia tax return? If NOT in Georgia, which state: TUITION CLASSIFICATION SECTION 3 If you are UNDER THE AGE OF 24, these questions relate to YOUR parent, courtappointed legal guardian, or spouse. 1. RESIDENCY DURATION: Check the box if you have a parent, courtappointed legal guardian, or spouse who is a legal resident of Georgia who has continuously resided in Georgia more than 12 months (exclude temporary trips, etc.) 2. DRIVERS LICENSE: Do they have a driver s license or stateissued ID? If YES, was it issued in Georgia? If NOT from Georgia, which state? 3. MOTOR VEHICLE: Do they own a motor vehicle? If YES, is it registered in Georgia? If NOT in Georgia, which state? 4. VOTER REGISTRATION: Are they registered to vote? If YES, are they registered to vote in Georgia? If NOT in Georgia, which state? 5. STATE TAXES: Did they file a state income tax return? If YES, did they file a Georgia tax return? If NOT in Georgia, which state? TUITION CLASSIFICATION SECTION 4 Answer these questions, IF APPLICABLE, related to the military. 1. I am, my parents are (if you are under 24), or my spouse is a member of the U.S. Armed Forces (check one or more) If you are a member, which branch (circle one): Air Force, Army, Coast Guard, Marines, Navy Which component are you in (circle one): Active, Reserve, National Guard Your current status (circle one): Discharged, Retired, Serving 2. I am, my parents are (if you are under 24), or my spouse is active duty military, stationed in Georgia (check one or more) If this person is currently on active duty, provide their Home of Record: State 3. I am, my parents are (if you are under 24), or my spouse is currently a member of the Georgia National Guard. (check one or more) RUN WITH THE WOLVES. Continue on back

6 OTHER INFORMATION How did you first hear about us? Mark ONLY one: Friend or Family High School Visit UWG Student Probe College Fair Facebook Billboard Magazine AdArticle Magazine Radio Zinch Cappex Newspaper AdArticle Other Web Site TelevisionMovie Commercial High School Counselor UWG Web Site Workplace Other Which of these were you involved with in high school (select all that apply)? Honors AP Courses Literary Magazine Debate Concert Band Marching Band Color Guard Chorus Newspaper Radio Student Government Theatre TV Show Production (News, etc) Which of these interest you at UWG? Choose TWO: Academic Tutoring Band Chorus Campus Community Service Debate Baseball Basketball Cheerleading Cross Country I understand that any material false statement made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance with O.C.G.A , which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution. Further, I certify that, to my best knowledge, the information submitted on this application is true and complete, and if accepted, I agree to abide by the regulations of the University of West Georgia. SIGNATURE OF APPLICANT: MAJOR CODE MAJOR CODE MAJOR CODE Accounting P001 Anthropology P004 Art (Education, History, Visual Arts, & Graphic Design) P500 Biology 0800 Chemistry (BA) 140A Chemistry (BS) 1400 Chemistry Engineering 1410 Chemistry Secondary Education 1430 Computer Science 1600 Criminology P018 Early Childhood Education P019 Earth Science Secondary Education 2010 Economics (BBA) P021 Economics (BS) 2200 Economics Secondary Education 2210 English 2300 English Secondary Education 2301 Environmental Science 2410 Environmental Studies 2400 Finance P025 French 2600 French Education 2601 Geography Human (BA) 2800 Geography Physical (BS) 2803 Honors Program International Club InternshipCoOp Program Intramurals Leadership Programs Football Golf SIGNATURE Literary JournalMagazine Newspaper Student Activities Council Multicultural Organizations RadioTV Which UWG intercollegiate sport interests you most? (if you are not interested in sports you may leave this blank) UWG Application Major Codes When completing the UWG undergraduate application, please use the codes below to answer the question on Intended Academic Major. Geography Geographic Info Systems 2805 Geology 2900 Geology Engineering 2910 Geology Environmental 2904 German 3000 Global Studies 3150 History 3300 History Secondary Education 3301 International Economic Affairs 3400 Management P036 Management Information Systems P365 Marketing P037 Mass Communications P038 Mathematics (BA) 3900 Mathematics (BS) 3908 Mathematics Secondary Education 3904 Middle Grades LangSoc Stud 4108 Middle Grades MathScience 4109 Music Business Studies 2250 Music Composition 7720 Music Education 4200 Music Performance 4600 Nursing P043 Philosophy 4700 Soccer Softball Religious Organizations Social Sororities and Fraternities Student Government Study Abroad Theatre Tennis Volleyball DATE: Philosophy Religion 4701 Physical Education P048 Physics 4900 Physics Engineering 5000 Physics Secondary Education 4910 Political Science (BA) 5100 Political Science (BS) 5101 PreLaw 5104 PreMedicine 0801 PrePharmacy 1401 Psychology P053 Real Estate P056 Sociology P068 Spanish 6900 Spanish Education 6901 Special Education P705 SpeechLanguage Pathology P076 Sport Management P450 Theatre P077 UndecidedUndeclared 0000 Undecided Business 0010 Undecided Education 0020 Undecided Humanities 0030 Undecided MathScience 0040 Undecided Social Science