APPLICANT. Legal Name Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.

Transcription

1 APPLICANT Legal Name Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc. Preferred name, if not first name (only one) Former last name(s) Birth Date Female Male US Social Security Number, if any Required for US Citizens and Permanent Residents applying for financial aid via FAFSA Preferred Telephone Home Cell Home ( ) Cell ( ) Address IM Address Permanent home address Number & Street Apartment # City/Town County or Parish State/Province Country ZIP/Postal Code If different from above, please give your current mailing address for all admission correspondence. (from to ) () () Current mailing address Number & Street Apartment # City/Town County or Parish State/Province Country ZIP/Postal Code If your current mailing address is a boarding school, include name of school here: FUTURE PLANS Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants. College Deadline Entry Term: Fall (Jul-Dec) Spring (Jan-Jun) Do you intend to apply for need-based financial aid? Yes No Decision Plan Do you intend to apply for merit-based scholarships? Yes No Academic Interests Do you intend to be a full-time student? Yes No Do you intend to enroll in a degree program your first year? Yes No Career Interest Do you intend to live in college housing? What is the highest degree you intend to earn? DEMOGRAPHICS Citizenship Status Non-US Citizenship(s) _ Birthplace City/Town State/Province Country Years lived in the US? Years lived outside the US? Language Proficiency (Check all that apply.) S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home) S R W F H Optional The items with a gray background are optional. No information you provide will be used in a discriminatory manner. Religious Preference US Armed Services veteran status 1. Are you Hispanic/Latino? Yes, Hispanic or Latino (including Spain) No If yes, please describe your background. 2. Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more and describe your background.) American Indian or Alaska Native (including all Original Peoples of the Americas) Are you Enrolled? Yes No If yes, please enter Tribal Enrollment Number Asian (including Indian subcontinent and Philippines) Black or African American (including Africa and Caribbean) Native Hawaiian or Other Pacific Islander (Original Peoples) White (including Middle Eastern) 2012 The Common Application, Inc. AP-1 /

2 FAMILY Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information for demographic purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then please list that information below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the Additional Information section. Household Parents marital status (relative to each other): Never Married Married Civil Union/Domestic Partners Widowed Separated Divorced (date ) mm/yyyy With whom do you make your permanent home? Parent 1 Parent 2 Both Legal Guardian Ward of the Court/State Other If you have children, how many? Parent 1 Mother Father Unknown Is Parent 1 living? Yes No (Date Deceased ) mm/yyyy Last/Family/Sur First/Given Middle Former last name(s) Country of birth Home address if different from yours Preferred Telephone: Home Cell Work ( ) Occupation Employer Parent 2 Mother Father Unknown Is Parent 2 living? Yes No (Date Deceased ) mm/yyyy Last/Family/Sur First/Given Middle Former last name(s) Country of birth Home address if different from yours Preferred Telephone: Home Cell Work ( ) Occupation Employer College (if any) College (if any) Graduate School (if any) Graduate School (if any) Legal Guardian (if other than a parent) Relationship to you Last/Family/Sur First/Given Middle Country of birth Home address if different from yours Preferred Telephone: Home Cell Work ( ) Occupation Employer College (if any) Graduate School (if any) Siblings Please give names and ages of your brothers or sisters. If they are enrolled in grades K-12 (or international equivalent), list their grade levels. If they have attended or are currently attending college, give the names of the undergraduate institution, degree earned, and approximate dates of attendance. If more than three siblings, please list them in the Additional Information section. Name Age & Grade Relationship College Attended CEEB Degree earned Dates or expected mm/yyyy mm/yyyy Name Age & Grade Relationship College Attended CEEB Degree earned Dates or expected mm/yyyy mm/yyyy Name Age & Grade Relationship College Attended CEEB Degree earned Dates or expected mm/yyyy mm/yyyy 2012 The Common Application, Inc. AP-2 /

3 EDUCATION Secondary Schools Most recent secondary school attended Entry Date Graduation Date School Type: Public Charter Independent Religious Home School mm/yyyy Address CEEB/ACT Code Number & Street City/Town State/Province Country ZIP/Postal Code Counselor s Name Counselor s Title Telephone ( ) Fax ( ) Number Ext. Number List all other secondary schools you have attended since 9 th grade, including academic summer schools or enrichment programs hosted on a secondary school campus: School Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yyyy) Please list any community program/organization that has provided free assistance with your application process: If your education was or will be interrupted, please indicate so here and provide details in the Additional Information section: Colleges & Universities List all college/university affiliated courses you have taken since 9th grade and mark all that apply: taught on college campus (CO); taught on high school campus, excluding AP/IB (HS); taught online (ON); college credit awarded (CR); transcript available (TR); degree candidate (DC). College/University Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) CO HS ON CR TR DC Dates Attended Degree Earned mm/yyyy mm/yyyy If you indicated that a transcript is available, please have an official copy sent to your colleges as soon as possible. ACADEMICS The self-reported information in this section is not intended to take the place of your official records. Please note the requirements of each institution to which you are applying and arrange for official transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where Best Scores are requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates. Grades Class Rank Class Size Weighted? Yes No GPA Scale Weighted? Yes No (if available) (if available) ACT Exam Dates: Best Scores: (past & future) mm/yyyy mm/yyyy mm/yyyy (so far) COMP mm/yyyy English mm/yyyy Math mm/yyyy Reading mm/yyyy Science mm/yyyy Writing mm/yyyy SAT Exam Dates: Best Scores: (past & future) (so far) Critical Reading Math Writing TOEFL/ Exam Dates: Best Score: IELTS (past & future) mm/yyyy mm/yyyy mm/yyyy (so far) Test Score mm/yyyy AP/IB/SAT Best Scores: Subjects (per subject, so far) mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score Current Courses Please list all courses you are taking this year and indicate level (AP, IB, advanced, honors, etc.) and credit value. Indicate quarter classes taken in the same semester on the appropriate semester line. Full Year/First Semester/First Trimester Second Semester/Second Trimester Third Trimester or additional first/second term courses if more space is needed 2012 The Common Application, Inc. AP-3 /

4 Honors Briefly list any academic distinctions or honors you have received since the 9 th grade or international equivalent (e.g., National Merit, Cum Laude Society). S(School) S/R(State or Regional) N(National) I(International) Grade level or Honor Highest Level of post-graduate (PG) Recognition PG S S/R N I EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (specific events, varsity letter, musical instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a résumé. Grade level or post-graduate (PG) PG Hours per week Approximate time spent Weeks per year When did you participate in the activity? Summer/ School School year Break Positions held, honors won, letters earned, or employer If applicable, do you plan to participate in college? Activity Activity Activity Activity Activity Activity Activity Activity Activity Activity 2012 The Common Application, Inc. AP-4 /

5 WRITING Please briefly elaborate on one of your extracurricular activities or work experiences in the space below. Please write an essay of words on a topic of your choice or on one of the options listed below, and attach it to your application before submission. Please indicate your topic by checking the appropriate box. This personal essay helps us become acquainted with you as a person and student, apart from courses, grades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and express yourself. NOTE: Your Common Application essay should be the same for all colleges. Do not customize it in any way for individual colleges. Colleges that want customized essay responses will ask for them on a supplement form. Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you. Discuss some issue of personal, local, national, or international concern and its importance to you. Indicate a person who has had a significant influence on you, and describe that influence. A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an experience that illustrates what you would bring to the diversity in a college community or an encounter that demonstrated the importance of diversity to you. Topic of your choice. Additional Information Please attach a separate sheet if you wish to provide details of circumstances or qualifications not reflected in the application. Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence. Disciplinary History Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9 th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution. Yes No Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? Yes No [Note that you are not required to answer yes to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.] If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reflects on what you learned from the experience. Note: Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history. SIGNATURE Application Fee Payment If this college requires an application fee, how will you be paying it? Online Payment Will Mail Payment Online Fee Waiver Request Will Mail Fee Waiver Request Required Signature I certify that all information submitted in the admission process including the application, the personal essay, any supplements, and any other supporting materials is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree, should the information I have certified be false. I acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school. I affirm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of my admission offers from all institutions. [Note: Students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted from the waitlist, provided that they inform the first institution that they will no longer be enrolling.] Signature Date Common Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex, age, marital status, parental status, physical disability, learning disability, political affiliation, veteran status, or sexual orientation The Common Application, Inc. AP-5 /

6 Supplement to the Common Application Personal Information Legal Name of Applicant: Last/Family First/Given Middle Suffix (if any) Enter name exactly as it appears on passports or other official documents. Permanent Home Address: Street Address 1 or P.O. Box Street Address 2 City or Town State/Province Country Zip/Postal Code U.S. Social Security Number (optional): (This does not apply to international students.) Your social security number expedites the process of matching information, and is required if you are applying for financial aid. If your name may appear differently on any of your documents, please indicate that here: Date of Birth: Please note: International Students must provide a home country address above. US Permanent Residents must mail a copy of both sides of the Permanent Resident Card. Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must mail a copy of the documentation of their status. Other Visa: Please mail a copy of your current visa. Family Mail to: University of Rhode Island Office of Admission Newman Hall, 14 Upper College Road Kingston, RI Did any family members earn a degree from the University of Rhode Island? Yes No If yes, please list. Name Graduation Year Relationship

7 Residency Are you a resident of the State of Rhode Island? Yes No If you are an undocumented student who has lived in Rhode Island for three or more years and has earned or will earn a Rhode Island high school diploma or GED, please refer to the residency policy for undocumented students on at If you have a non Rhode Island permanent home address and are claiming Rhode Island residency, you must submit a notarized Rhode Island residency application and all supporting documentation. This information is available at Are you a U.S. citizen in the armed forces currently stationed in Rhode Island or the dependent of such a person? Yes No If yes, please send us a copy of the current military orders with assignment to Rhode Island. Are you a veteran of the US Armed Forces who is currently domiciled in Rhode Island, or dependent of such a person? If so, please refer to the pertinent section of the residency policy and submit the application for Rhode Island residency for tuition purposes. ( International Applicants Requiring English as a Second Language Instruction International students (non-us citizens or non-permanent Residents of the US): please answer the questions below. I am an international student applying for CONDITIONAL ADMISSION only. I plan to enroll full-time in the intensive English language program offered by the A.C.E. Institute on the main URI campus. Yes No I am an international student applying for CONDITIONAL ADMISSION and plan to study intensive English at one of the EC Centers. Yes No I am an international student at the Roosevelt International Academy applying for CONDITIONAL ADMISSION. Yes No Your Academic Interest If you are undecided about your major, you may select totally undeclared, or you may select the undeclared major option within each of the colleges at URI (except for the Colleges of Nursing and Pharmacy). Certain majors cannot accommodate all of the qualified students who apply. We encourage you to indicate a second major choice. Listing a second major choice will not decrease your chances of being admitted to your first choice major. If you are not admissible to your first choice major and you do not list a second choice major, you will not be admitted to URI. Due to space limitations and the competitive nature of the programs in the Colleges of Nursing, Pharmacy, and Engineering, preference will be given to students who submit all required application materials by December 1.

8 Attention College of Pharmacy Applicants: If you intend to become a licensed pharmacist, you should select the Pharmacy major (six-year doctorate). Applicants to this program must include an additional paragraph (250 words or fewer) on a separate sheet explaining their choice of major, as well as two letters of recommendation: one from a science or math teacher, and one from a guidance counselor or teacher of another subject. Please note: The B.S. in Pharmaceutical Sciences (four-year program) prepares you to work in the pharmaceutical field in areas such as drug development and research, but does not prepare you to become a licensed pharmacist. For more information, see Attention Music Applicants: Auditions are required for all Music majors for both admission purposes and select department scholarship opportunities. All academically qualified students are initially admitted into the B.A. in Music major. Students who choose one of the three Bachelor of Music majors (Music Composition, Education, or Performance) will be placed into that major following enrollment. The auditions will be held on the following Saturdays: December 8, 2012, January 26, 2013, and February 9, For more information, see Transfer applicants should refer to uri.edu/admission for information regarding admission requirements and deadlines. If you are interested in the certificate in Biotechnology Manufacturing offered at the Providence Campus, please select the Medical Laboratory Science Major in the College of the Environment and Life Sciences. First choice major (required) Second choice major (recommended) SAT/ACT Scores Although you may have reported your own scores on the Common Application, please note that we will only accept scores sent to us by the College Board or ACT. College Level Credit If you have enrolled in college courses for credit prior to enrolling at URI, please indicate the total number of credits below. You must disclose all current and previous enrollment(s) at other post-secondary institutions. Number of College Credits: Providence Campus

9 In addition to the main campus in Kingston (which offers all undergraduate majors), the University of Rhode Island has an urban campus without residence halls in Providence which offers the following degrees: Communication Studies, English, History, Human Development and Family Studies, Medical Laboratory Science & Biotechnology Manufacturing, and Psychology. It is also possible to attend this campus as an undecided student and complete many of the general education requirements. Please select only one: I am interested in enrolling as a student at URI s main campus in Kingston, which offers on-campus housing. I am interested in enrolling as a student at URI s Providence campus, which does not offer on-campus housing, and is located 45 minutes north of the main campus. Talent Development (TD) Applicants Talent Development Applicants must include a personal statement explaining why they believe they are eligible for the Talent Development program. (If you have included this information in your Common Application essay, then please proceed to the Talent Development fee waiver section). Talent Development Fee Waiver For all TD applicants the application fee is waived, and the application is designated as TD through the entry of a valid TD fee waiver code. High school students may obtain a fee waiver code from their high school guidance office. CCRI transfer students and students not currently in school should contact the TD Office at to obtain a code. Application Fee Waiver Code: Please note: TD fee waiver codes are case-sensitive. Please check your To Do List at uri.edu/e-campus to verify that your TD fee waiver code was accepted.