Application Checklist

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1 Application Checklist Listed below are the items that need to be completed for admission to Gallaudet University Adult Degree Program. Check to make sure each item has been sent to us. Your application cannot be reviewed until we receive all items on the list. Eligibility Requirement Will you be 24 or older on the first day of class or be able show evidence of financial independence? Please check one box: Yes, I will be 24 years or older on the first day of class. Please proceed with the application. Yes, I am financially independent and I will submit a copy of my most recent year s tax return to show fiscal independence. Please proceed with the application. No, I will not be 24 by the first day of class and I am not financially independent. At this time, you will not be eligible for the Adult Degree Program. Please apply for Gallaudet s Undergraduate Program. (Go to admissions.gallaudet.edu/index.htm for further information.) Checklist: 1. Gallaudet University Adult Degree Program Application Form 2. Application Processing Fee - $50 3. Application Essay Tell Us About You (included as a part of this application) 4. Transcript(s) - Have you received any college credit? If yes, please submit all official transcripts from each college, university, and college-credit bearing program. (Note: If you do not submit your transcript(s), you may be required to take entrance exams.) If no, please disregard this step. 5. Exam Scores - Have you taken 12 or more credit hours of college English and/or college Mathematics or achieved higher than a C- in all college courses? If yes, please disregard this step. If no, please submit the scores of at least one recent standardized test. ACT is preferred but international applicants must take the SAT. For those who take the ACT: Send scores to College Code 0662 SAT: Send scores to College Code 5240 (For test dates and locations near you, go to or 6. High School Diploma - Have you earned more than 12 college credits? If yes, please disregard this step. If no, please submit evidence of high school graduation or GED. 7. Audiogram completed by an audiologist or physician. (Hearing applicants may apply to the Adult Degree Program and do not have to submit an audiogram. Space in the program for hearing adult learners may be limited.) 8. Are you an international applicant? If yes, please have your education transcripts translated in English by a certified translator. If no, please disregard this step. 9. Do you owe the University money? Contact Information Adult Degree Program (202) (videophone/ voice) Admissions - Undergraduate (202) (videophone) (800) (TTY/voice) (202) (fax) Financial Aid Office (202) (videophone) (202) (TTY/voice) (202) (fax) Office of Student Conduct (202) (TTY/voice) (202) (fax) Registrar s Office (202) (TTY/voice) (202) (fax) Student Financial Services (888) (TTY) (888) (voice) (202) (fax) Tech Support (Helpdesk) (202) (videophone) (202) (TTY) (202) (voice) (202) (fax) University Operator (202) (TTY/voice) If yes, you must contact the university Student Financial Services. 10. Did you receive disciplinary suspension from Gallaudet? If yes, you must contact the university Office of Student Conduct for guidance for readmission. 1

2 Applying for Year 20 Session: January May October March August/September You may complete this application online at adp.gallaudet.edu. A VISA or a MasterCard is required for the online application. Personal Information For Office Use Only: PS ID# Application fee paid: Check Credit Card Money Order Signature: _Date: _ ADPDST ADCP Faculty Advisor Test: GPA: ARC: Full Legal Name: Last name First name Middle name Preferred Name: Birth/Maiden Name: Home Address: Address line 1 Address line 2 Social Security #: _ Date of Birth: // Birth State: Birth Country: Gender: Male Female Marital Status: Single Married Divorced Ethnic Group (Check all that apply.) Mailing Address (if different from above) American Indian/ Alaska Native Asian American Black/ African American Address line 1 Hispanic/ Latino Native Hawaiian/ Other Pacific Islander White/ Caucasian Address line 2 Other (specify ) Deaf Phone: TTY voice videophone Hearing Status (Check one.) Hard of Hearing Hearing DeafBlind Personal 2

3 Application Information Select your program of interest: Degree Completion Major: Deaf Studies Have you previously applied to Gallaudet? Yes If yes, were you admitted? Yes If yes, did you enroll? Yes If yes, what name did you use at the time of previous application? _ Are you presently a Gallaudet employee? Yes Are you a former Gallaudet employee? Yes Are you an immediate family member of a Gallaudet employee? Yes Citizenship US citizen/ native Dual US citizen. Please specify other country of citizenship US Permanent Resident visa. Citizen of Country of citizenship Alien Registration Number Do you require a visa? Yes Visa Type If you are not a US citizen and live in the United States, how long have you been in the country? Veterans Information Are you a veteran of the US Armed Services? Yes If yes, are you eligible for the Yellow Ribbon Program through the Department of Veteran Affairs? Yes If yes, select the branch of military: Air Force Army Coast Guard Marines Navy Dates of military service: From To Sign Language Usage Please rate your ability to communicate in sign language Native/ Excellent Good Fair Poor None How long have you been using sign language on a daily basis? Less than one year 1-2 years 3-5 years 5 years or more 3

4 Education Data High School/ Secondary Program Information Do you have a US high school or secondary school diploma or its equivalent? Yes Do you have a GED? Yes Did you do Home Study? Yes Date of secondary graduation: Name of secondary school graduated from: Postsecondary Education Information City and State of school: Please list all community colleges, colleges, universities, and credited training programs you attended, beginning with the most recent college, university, or college-credited training program. If you have attended five or more, please list these on a separate sheet of paper. Applicants must submit an official college transcript from every postsecondary school attended. Photocopies of transcripts cannot be accepted. Transcripts should be sent to Gallaudet University Office of Undergraduate Admissions Attn: ADP Admissions Counselor 800 Florida Avenue, NE Washington, DC Please allow three weeks processing time when sending transcripts and catalogs from other postsecondary schools to Gallaudet. If you have not attended any postsecondary schools, please check here. 1. Name of College/ University _ Address: Dates attended: Street 1 From: Street 2 To: Phone: 2. Name of College/ University _ Address: Dates attended: Street 1 From: Street 2 To: Phone: 3. Name of College/ University _ Address: Dates attended: Street 1 From: Street 2 To: Phone: 4. Name of College/ University _ Address: Dates attended: Street 1 From: Street 2 To: Phone: 4

5 Financial Aid Are you interested in applying for Financial Aid? Do you have a Vocational Rehabilitation Counselor? Yes (If yes, please do a FAFSA at Yes If yes, please complete the following VR Counselor: _ Last name First Name Middle Initial _ Address 1 _ Address 2 _ Phone: _ Fax: Essay Question TTY voice videophone Tell Us About You (You may mail your essay along with your application or fax it to ) Demographics, grades and test scores only reveal a little bit about who you are. Please write a one-page essay introducing yourself and your reasons for attending college. This is an opportunity for you to reflect on your attitudes, values and perceptions. Please include the following information, if applicable: Current job or community responsibilities that could demonstrate your ability to be a successful learner Career goals Resume detailing life and professional experience in your chosen major, e.g. Deaf Studies Family obligations Reasons why your previous educational records may not reflect your current abilities. We understand that people change. This is your chance to explain why the student you were in the past is not the same person you are now. 5

6 Conditions of Enrollment Date: My preferred major of study is. Please read each section and sign your initials in the space provided on the right side. I understand that ALL of my transcripts from previous and current credit-bearing programs, colleges, and universities need to be sent to Gallaudet to ensure expedient and accurate credit transfer. I understand that as a part of this applications process the Chair of my preferred major program will be notified of my intent to apply and may review this application and other academic records to make an admissions decision. Each department has different requirements for admission into the major. I will adhere to the application process as required by the department. I understand that I will be admitted into a major program if admitted into the Adult Degree Program and I will adhere to all requirements of the major. I understand that I will be required to successfully complete an online student orientation program. Enrollment fees ($100) will apply. Sign initials here. Marketing Data How did you learn about Gallaudet? (Check all that apply.) Academic Bowl Teacher Gallaudet Link Close Up Counselor Internet Summer camp Visiting faculty/staff Mail Sports camp Family member Newspaper/ magazine Knowledge for College Friend Recruiter presentation DVD Convention/ conference Students at Gallaudet University VR Recruiter visit Alumnus/ alumna Other: Have you ever visited Gallaudet? Yes If yes, through which program(s)? Academic Bowl Knowledge for College Homecoming Close Up Convention/ conference on campus Visitors Center Admissions Office Site Visit Sign language classes Summer camps Gallaudet Open House Sports camp Other: 6

7 Applicant Certification I understand that falsifying or withholding information in completing the application may result in the cancellation of my admission to the University and/or registration with the University. If I was previously a student at the University, I have successfully resolved any outstanding issues with the university Student Financial Services and Office of Student Conduct. I certify that the information provided in this application is true and correct. Applicant Signature: Date: Application Fee Application Fee Payment The required nonrefundable $50 application fee is a requirement and will not be waived. Applications arriving without the application fee will be considered inactive and will not be processed. Check #/ Money Order Name of Payee Credit Card # _ VISA MC Expiration Date Name on Account (please print) $ Date Card Owner Signature _ Appli cation Fee University Mailing Address Application Fee Please mail the completed application and all necessary application materials to Gallaudet University Undergraduate Admissions Office Attn: ADP Admissions Counselor 800 Florida Avenue NE Washington DC

8 Audiology Record Check with your physician, audiologist, and vocational rehabilitation counselor to see if a copy of your audiogram is on file. If they have one, please send it to Gallaudet s Office of Admissions and Part B will not need to be completed. If none of them have one, please have your physician or audiologist complete Part B. (Hearing applicants do not have to submit an audiology record.) PART A (to be completed by applicant) Applicant s Name Home Address City State Telephone TTY voice videophone Fax Zip PART B (to be completed by a certified audiologist) All of the information below is required for every applicant. Please return this completed form as soon as possible. 1. Onset of hearing loss: Birth Other Month Year 2. Cause of hearing loss: 3. Pure tone: Right Ear Date Admin. Frequency Air Hearing Level Indicated Standard Used: 1. ISO-ANSI Left Ear Bone Frequency Air Hearing Level Bone Name Title/ Position Agency/ School Address _ City State Telephone TTY voice videophone Zip Please mail or fax completed form to Office of Admissions Gallaudet University 800 Florida Avenue, NE Washington, DC (202) (fax) Fax 8

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