Undergraduate Application

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1 Undergraduate Application INSTRUCTIONS: 1. Type or print in ink. 2. Attach non-refundable $50 application fee and mail the Office of Admissions, The Evergreen State College, 2700 Evergreen Pkwy NW, Olympia, WA Request official transcripts mailed from all schools, colleges, and universities attended. These documents should be directed the Office of Admissions. 4. Sign and date application in section # To request disability accommodation in the application process, contact Evergreen s Office of Access Services, (360) or (360) (TTY). 1. I am applying as: o First-Time Freshman o Transfer Student o Returning Evergreen Student o International Student 2. I am applying the campus in: o Olympia (lower- and upper-division students) o Tacoma (upper-division only) o Tribal Site (upper-division only) 3. I am applying for: o Fall o Winter o Spring Check one quarter only. Year Year Year (International students may apply for Fall Quarter only.) 4. I have previously applied for admission at Evergreen: o No o Yes: Quarter / Year 5. I have previously attended Evergreen: o No o Yes: Dates of Attendance Year Year 6. I am a resident of Washingn state: o No o Yes: From Month / Year Month/Year (If yes, you must include dates of your most recent continuous residence in Washingn.) 7. Intended area of interest: First choice: Second choice: 8. I plan attend during evenings and weekends only: o No o Yes PERSONAL DATA 9. o Male o Female 10. Social Security Number 11. Legal Name (If applicable) By law, providing your Social Security Number is optional. Providing your SSN will assist in the processing of your admission and financial aid applications. It may also be used for educational research purposes. Releasing student information will be in accordance with all appropriate state and federal laws. The SSN is not used as the primary student ID at Evergreen. Family or Surname First or given Middle Jr., etc. 12. Former Name(s): If your first or last name has changed, indicate your former full name(s). Family First or given Middle Jr., etc. Family First or given Middle Jr., etc. 13. Mailing Address Please Note: All admissions correspondence will be mailed the Mailing Address (#13), not the Permanent Mailing Address (#15). Please notify the Office of Admissions two weeks prior for a change of Mailing Address Address (optional) 15. Permanent Mailing Address (if different from above) 16a. Telephone ( ) 16b. Alternate or mobile telephone ( ) 17. Date of Birth 18. Birthplace Month/Day/Year City State/Province Country if other than U.S. 19. Country of citizenship o U.S.A. (Skip #22) o Other 20. What is your country of permanent residence? 21. Current U.S. visa type (Specify country) Date visa granted 22. Are you a U.S. military veteran? o Yes o No Month / Year 1

2 Hispanic Origin and Racial Identity (OPTIONAL) Evergreen is required ask all applicants provide a response in these two sections. Your response(s) are optional. If you answer: No, I am non-hispanic in origin please consider indicating your race in the Racial Identity section. You may make more than one selection from those provided in the American Indian or Alaska Native, Asian, Black or African /American, Native Hawaiian or Other Pacific Islander and White subsections. And, where applicable, you may select Other and specify your race. HISPANIC ORIGIN (optional) 23. Are you Hispanic in origin? o No, I am non-hispanic in origin. o Yes, I am Hispanic in origin. (select one or more) o Argentinian o Bolivian o Chilean o Colombian o Costa Rican o Cuban o Dominican o Ecuarian (Ecuadorian) o Guatemalan o Honduran o Mexican or Mexican-American (Chicano) o Nicaraguan o Panamanian o Peruvian o Puer Rican o Salvadoran o Spanish o Uruguayan o Venezuelan o Other Hispanic Origin RACIAL IDENTITY (optional) 24. How do you describe your race? (select one or more) o American Indian or Alaska Native American Indian (select one or more) o Chehalis o Chinook o Colville o Cowlitz o Duwamish o Hoh o Jameswn o Kalispel o Kikiallus o Lower Elwha o Lummi o Makah o Muckleshoot o Nisqually o Nooksack o Port Gamble Klallam o Puyallup o Quileute o Quinault o Samish o Sauk-Suiattle o Shoalwater o Skokomish o Snohomish o Snoqualmie o Snoqualmoo o Spokane o Other American Indian o Squaxin Island o Steilacoom o Stillaguamish o Suquamish o Swinomish o Tulalip o Upper Skagit o Yakima Alaska Native (select one or more) o Alaska Aleut (Unangan) o Alaska Alutiq o Alaska Athabaskan o Alaska Eskimo (Inupiaq or Yupik) o Alaska Eyak o Alaska Haida o Alaska Tlingit o Alaska Tsimshian o Other Alaska Native o Asian (select one or more) o Asian Indian o Bangladeshi o Bhutanese o Burmese o Chinese o Filipino o Hmong o Indonesian o Cambodian (Kampuchean) o Japanese o Korean o Laotian o Madagascar o Malayan o Maldivian o Mongolian o Nepali o Pakistani o Singaporean o Sri Lankan o Taiwanese o Thai o Vietnamese o Other Asian o Black or African American o Native Hawaiian or Other Pacific Islander (select one or more) o Fijian o Guamanian o Kosraean o Mariana Islander o Marshall Islander o Micronesian o Native Hawaiian o Palauan o Papua New Guinean o Ponapean (Pohnpeian) o Samoan o White (includes people of European, Middle Eastern, or North African descent) o Solomon Islander o Tahitian o Tarawa Islander o Tokelauan o Tongan o Trukese (Chuukese) o Vanuatuan (New Hebrides Islander) o Yapese o Other Pacific Islander o Other 2

3 FAMILY INFORMATION Evergreen is interested in collecting accurate information about your parents, including their education. Your answers will be used support Washingn state and federal government programs address the needs of college students. You are encouraged complete this section of the application even if you are no longer a dependent. Parent / legal guardian Circle one: Ms. Mrs. Mr. Dr. 25. Name Is s/he living? o Yes o No (skip #26) Telephone ( ) Last First Address (optional) Mailing Address 26. Parent or guardian s highest o Some high school o HS graduate o Some college level of formal education completed: o 2-yr. college degree o 4-year college degree o Postgraduate study College/university attended: Parent / legal guardian Circle one: Ms. Mrs. Mr. Dr. 27. Name Is s/he living? o Yes o No (skip #28) Telephone ( ) Last First Address (optional) Mailing Address 28. Parent or guardian s highest o Some high school o HS graduate o Some college level of formal education completed: o 2-yr. college degree o 4-year college degree o Postgraduate study College/university attended: Former Foster Care Youth Scholarship and financial aid grant opportunities are available for former foster care youth. The Governors Scholarship for Foster Youth and Passport for Foster Youth Promise scholarship program encourages foster care youth prepare for and succeed in college. Your answer question 29 may allow Evergreen see if you qualify for financial aid grants. 29. Were you a former foster care youth in Washingn state? o No o Yes More information about these programs is available online: Washingn State Governors Scholarship for Foster Youth - Passport for Foster Youth Promise - EDUCATIONAL BACKGROUND AND OBJECTIVES 30. List all high schools attended during grades 9 through 12, beginning with the most recent: High School City State/Country Grade Level 31. Have you graduated or will you graduate from high school? o No o Yes: (skip #33) 32. Did you take the G.E.D. test? o No o Yes: 33. Have you ever attended school outside the U.S.? o No (skip #36) o Yes Mo/yr of graduation 34. At what level did you begin school in the U.S.? o K-7 o 8 o 9-12 o College or university o No school in U.S. 35. Before coming the U.S., what language was used for instruction in your school(s)? 3

4 ADMISSIONS TESTS ACT or SAT test scores are required for all freshman applicants who are 24 years of age or younger and from transfer students with fewer than 40 transferable quarter credits earned at the time of application. This test score requirement includes freshman applicants who have earned, or will earn, college credit prior graduating from high school. You must arrange have official scores sent directly from the testing agency or by your high school guidance office. Test of English as a Foreign Language (TOEFL) scores are required of all international applicants for whom English is not the primary language used for instruction. You must arrange have official scores sent directly from TOEFL Evergreen. FRESHMEN FROM HIGH SCHOOL ONLY Complete this section regardless of the number of college credits earned before high school graduation. 36. Senior Year Courses List all the high school and college credit courses you are taking and plan take in your senior year (grade 12) and in the summer before you enroll at Evergreen. Notify the Admissions Office of any changes. Misrepresenting your schedule and/or failure complete courses listed may jeopardize your admission status. For each term, write the course title(s) and number of credits (usually, 1 credit = 1 full year; 1/2 credit = 1 semester; 1/3 credit = 1 trimester). Example: English 101, 5 credits. Term 1 Term 2 Term 3 Check box: o Sem. 1 o Qtr. 1 o Other o Sem. 2 o Qtr. 2 o Other o Qtr. 3 o Summer o Other Course Title Credits Course Title Credits Course Title Credits English Mathematics Science Social Science Foreign Language Fine/Performing Arts Other 37. Did you earn college credit during your junior year in high school? o No o Yes: Credits earned Name of the high school-college program? For example: Running Start, Washingn Name(s) of college(s) attended? 38. How many college credits do you expect earn during your senior year in high school? Name of the high school-college program? For example: Running Start, Washingn Name(s) of college(s) attended? 39. Do you plan take other courses for college credit after high school graduation, but before enrolling at Evergreen? o No o Yes complete sections 40 and 45 on the back page. Official college transcripts are required for transfer credit be awarded by Evergreen. Applicant: Your application is complete only if you sign and date the application in #46. 4

5 TRANSFER APPLICANTS WITH COLLEGE CREDIT ONLY 40. List in order of attendance and have all official transcripts sent from all colleges or universities you have ever attended or will attend before enrollment at Evergreen. Do not exclude or omit any colleges, regardless of how may credits you earned there or the nature of the program in which you were enrolled. Name of College/University Location Dates of Attendance City/State (month/year) (month/year) 41. Will you be a Washingn resident transferring from a Washingn community college with an academic associate degree, or Direct Transfer Agreement? o No o Yes 42. Have you earned a degree (AA, AA&S, BA, BS, etc.)? 1. o No o Yes (please indicate at right) 2. College Name of degree Date of Degree 43. Do you expect earn a degree before entering Evergreen? o No o Yes: Name of degree 44. Are you currently or will you be enrolled in a college or university prior entering Evergreen? o No o Yes: Name of college/university 45. List all courses you are taking or plan take between now and when you enter Evergreen. Expected date of degree Course # Short Course Title Term/Year Credits SIGNATURE 46. In signing this form, I acknowledge that failure disclose and submit official transcripts from all schools, colleges, or universities attended and failure disclose and submit complete and accurate information may result in the denial of admission or subsequent dismissal from said institution. I certify that the best of my knowledge statements I have made in this application are complete and true. I hereby give permission release appropriate test scores and academic records requested by said university or college. I understand that my application is incomplete without my signature below. Signature of Applicant Date Washingn baccalaureate colleges and universities provide equal opportunity in education without regard race, color, creed, religion, national origin, gender, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam-era veteran in accordance with institutional policies and applicable federal and state statutes and regulations. 5

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