1 Instructions: Freshman Submit either a paper or an electronic application (www.applytexas.org), NOT BOTH. We encourage you to apply online. Enter Fall, Spring, Summer I, or Summer II, and enter the year you plan to begin attending. Check if you are applying as a freshman with no college credit hours or as a freshman with college credit hours and indicate the number of college credit hours you will earn by your high school graduation date. Consider dual/concurrent enrollment but not Advanced Placement/International Baccalaureate courses as college credit hours. * Questions marked with an asterisk (*) are optional, but including the information may assist your admittance. You are strongly encouraged to complete these questions.. Part I. Biographical Information 1. Enter your Social Security number. The Social Security number is important to match the application with your grade transcript and test scores. The Social Security number is required to give (disburse) financial aid. NOTE: While no specific legal authority requires you to list your Social Security number for the purpose of applying for admission to the university, not providing the information will hold up further processes, such as financial aid. 2. Enter your date of birth (month, day, year). Do not leave blank; this information is required. 3. Enter your full, legal name: last, first, and middle. Do not use nicknames or abbreviations because this information will be used for your official record if you enroll. Use your full, legal name on all documents sent to the institution to which you are applying. 4. Enter other names, if any, under which your transcripts or other credentials may be listed. If you attended school using a different name or took a standardized college entrance exam using a different name, please list name(s). 5. Designate whether you are male or female. 6. Enter the city, state, and country where you were born. 7. This question is designed to identify your ethnicity and race. (a) Indicate whether or not your ethnicity is Hispanic or Latino. Check yes if you are a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Check no if you are not. (b) Select the racial category or categories with which you most closely identify. Check as many as apply: American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment. Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam Black or African American: A person having origins in any of the black racial groups of Africa.. Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. 8. Answer the questions regarding your citizenship status. If you have one, be sure to include with your application a copy of your permanent resident card and/or Notice of Action from the USCIS. 9. Indicate if you are connected to the military in any way by checking all categories that apply to you. If none apply, leave the question blank. 10. Enter your mailing/permanent mailing address and phone numbers. Use the Texas county codes and the two-letter state abbreviations listed on pages xix and xx. Use the county code if your permanent address is in Texas; if it is not, you do not need to provide a code. 11. Enter your physical address only if it is different from your permanent mailing address. 12. Enter phone number. 13. Enter the name, address, phone number, and of an emergency contact person 14. Enter your address. The address provided may be used to communicate important information to you regarding your application. 15. Indicate the highest level of your parents or courtappointed legal guardians educational background. *16. Indicate what languages (other than English) you speak fluently and for what length of time you have spoken them. *17. Indicate your family s gross income, including both taxed and untaxed income, for the most recent tax year. *18. Indicate how many people, including yourself, live in your household on a long-term basis. Include brothers and sisters who are in college. *19. Indicate whether or not you have family obligations that have prevented you from participating in extracurricular activities. Note if the obligation is: (a) working to supplement the family income, (b) providing primary care
2 for a family member, or (c) other obligations. Describe the nature of your particular family obligation(s); i.e., the type of activity, time required, etc. 20. Indicate type of freshman. 21. Enter the name, city, state, and College Board or ACT high school code (see your high school counselor) of the high school from which you graduated or expect to graduate. Indicate if you are home-schooled. Enter the month and year you graduated or expect to graduate. Have an official transcript sent to each college or university to which you apply. Indicate if you will graduate with an International Baccalaureate (IB) diploma. Indicate if you will graduate from a Texas public high school with the Recommended or Distinguished Achievement Program. 22. If you did not or will not graduate from high school, indicate whether or not you have a GED, whether it is the English or Spanish version, the month and year you completed the GED, and in what state you received it. 23. Prior to enrolling at this institution, if you have enrolled or will enroll in any college coursework, including college-level correspondence study and dual credit, indicate all previous colleges or universities you have attended or are attending, dates attended, and hours earned. Have an official transcript sent to each college or university to which you apply from each college or university you have attended. 24. If you answer 23, you must answer Indicate whether you want to participate the in reverse transfer program. 26. Indicate semester and year you anticipate to enroll 27. Indicate whether you plan to pursue a pre-professional program (e.g., pre-law, pre-medicine, nursing, pre-dental, pre-veterinary, physical therapy, etc.). 28. Check Yes if you plan to seek a teaching certificate in addition to your degree and No if you do not. If Yes, indicate if you will be seeking elementary level (Early Childhood-Grade 6); middle/junior high level (Grades 4-8); high school level (Grades 8-12); or all-level certification. 29. Enter your senior year schedule. Beside each course, indicate if the course is Advanced Placement ( AP ), International Baccalaureate ( IB ), dual credit or concurrent enrollment, and the semesters or trimesters the course was taken or will be taken. For example: Senior Courses AP/IB Dual Credit/ Semester or Trimester Concurrent Enrollment English X Physics AP 30. Indicate the date you took or plan to take the ACT, SAT, or one of the following tests for international students: the TOEFL (Test of English as a Foreign Language) or IELTS (International English Language Testing System) test. Residency Information Answer all questions that apply to you. Instructions are noted throughout the questions. 36. Write down any additional information that would help your college or university classify you as a Texas resident. 37. Read each statement carefully. Sign your name and include the date to indicate you understand and agree with each statement. Part II. Activities Provide information in any or all of the four categories listed. Some examples are: Extracurricular Activities - offices held in clubs, whether elected or appointed Community or Volunteer Service Talents/Awards/Honors - sports, cheerleading, musical ability, academic honors, or any type of awards or certificates received Employment/Internships/Summer Activities - jobs or internships that indicate special interests, abilities, challenges, or achievements You may submit a résumé in addition to this list. Attach it to your application and make a note that you have done so. Spell out names of organizations, clubs, honors, awards, etc.; do not use acronyms. Essays Most colleges and universities in Texas do not require essays as part of the admission process. Check General Application Information or the web site at to determine institutions requirements for essays. Be sure to include your name and Social Security number on each of your essay pages and enclose your essays with your application. If you apply electronically, also include on your essays the web identification number you are given. Application Fee Application fees are included in General Application Information. Include the student s name and Application ID number on your check or money order. Check the website of the institution(s) to which you are applying to see if credit card payment of the application fee is also accepted. Students with financial need should check with their high school counselor or the institution(s) to which they are applying for information concerning a possible waiver of the application fee (i.e., college application fee waiver).
3 ApplyTexas Application Freshman Admission THIS APPLICATION SHOULD NOT BE USED BY INTERNATIONAL STUDENTS. You are encouraged to complete this application online at This application is intended for use in applying for Academic Year Write in the name of the college or university to which you are applying. On the line below the institution s name, write in your firstchoice and second-choice majors. You can find the majors and codes/abbreviations online at or on institution websites. Institution: (Semester / Year) Major: (Major Name--First Choice) (Major Name--Second Choice) PART I. BIOGRAPHICAL INFORMATION 1. U. S. Social Security Number*: * Used for purposes of identity of your application, grade transcript, test scores, and financial aid. 2. Date of Birth (Required): (mm/dd/yyyy) (Month/Day/Year) 3. Full, Legal Name: (Last Name/Family Name) (First Name) (Middle Name) (Suffix: Jr., etc.) 4. Other names and aliases: If you attended school using a different name or took a standardized college entrance exam using a different name, please list name(s): 5. Gender: Male Female 6. Place of Birth (Required): (City) (State) (Country if not U.S.) 7. Ethnicity and Race: The information in this question will be used for federal and/or state law reporting purposes and may be used by some institutions in admission or scholarship decisions. (a) Are you Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)? Yes No (b) Select the racial category or categories with which you most closely identify. Check as many as apply. American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White 8. Are you a U.S. citizen? (Response required.) Yes No (a) If No, of what country are you a citizen? (b) If you are not a citizen, do you hold U. S. Permanent Resident status (valid I-551)? Yes No If Yes, date permanent resident card* issued: // Alien Number**: *Enclose a copy of both sides of the card. (Month) (Day) (4-digit Year) **Failure to provide Alien Number may delay processing. (c) If you are not a U.S. citizen or permanent resident, do you have an application for permanent residence (form I-485) pending with the U. S. Citizenship and Immigration Services (USCIS)? Yes No (If Yes, enclose a copy of your Notice of Action from the USCIS, form I-797C.) (d) If you are not a citizen or permanent resident or have no application pending with the USCIS, did you live or will you have lived in Texas for 36 consecutive months leading up to high school graduation or completion of the GED? Yes No (If Yes, please submit a completed Affidavit of Intent to Become a Permanent Resident. The affidavit is usually available from a college or university s admissions or international admissions office.)
4 (e) If you are not a U.S. citizen or U.S. permanent resident, are you a foreign national here with a visa that makes you eligible to domicile for Texas residency purposes or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status? Yes No (If Yes, please submit a copy of your Notice of Action from the USCIS, form I-797C, or a copy of your current visa.) 9. Status as a current U.S. military servicemember, veteran, or dependent: A U.S. military servicemember is a person who is serving in any branch of the U.S. Armed Forces, including the National Guard or Reserves. Please select any of the following that apply to you. I am a: Veteran (former U.S. military servicemember) Current U.S. military servicemember Spouse or dependent of, or a veteran or current U.S. military Servicemember with an injury or illness resulting from military service (service-connected injury/illness) Spouse or dependent of a veteran or a current U.S. military service member Spouse or dependent of a deceased U.S. service member 10. Permanent Address (Required): Street Address: Apt # City: County: State: Zip: Country: 11. Physical Address (Current street address where you reside if different from above. If your physical address is the same as your Permanent Address, leave this question blank.): Street Address: Apt #: City: County: State: Zip: Country: 12. Phone Numbers: Preferred Phone (Required): ( ) Preferred Phone Type (Required) (home, work, cell) Alternate Phone: ( ) Alternate Phone Type (home, work, cell) 13. Emergency Contact (Required): Name Mr. Mrs. Ms. (Last Name/Family Name) (First Name) Street Address: Apt #: City: County: State: Zip: Country: Phone: for Emergency Contact: 14. Your Address (Required): 15. Please indicate the highest level of your parents or legal guardians educational background: Father/Legal Guardian: No high school some high school High school diploma or GED Some College Associate s/2-year Degree Bachelor s/4-year Degree Graduate/Professional Degree Unknown Mother/Legal Guardian: No high school some high school High school diploma or GED Some College Associate s/2-year Degree Bachelor s/4-year Degree Graduate/Professional Degree Unknown 16. In addition to English, what languages do you speak fluently? Language 1 Language 2 Years spoken Years spoken
5 17. Please indicate your family s gross income for the most recent tax year. Include both untaxed and taxed income. Less than $20,000 $20,000-$39,999 $40,000-$59,999 $60,000-$79,999 $80,000-$99,999 $100,000-$149,999 $150,000-$199,999 $200,000 and above Unknown 18. How many people, including yourself, live in your household (Required)? (Include brothers/sisters attending college.) 19. Do you have family obligations that keep you from participating in extracurricular activities? Yes No If yes, do you: (a) Have to work to supplement family income? Please describe. (b) Provide primary care for family member(s)? Please describe. (c) Have other family obligations that prevent participation? Please describe. Supplemental Parental Information (Not required by all institutions; check with the Admissions Office.) Parent/Guardian 1: Relationship to you Name: (Title: Mr., etc.) (Last Name) (First Name) (Middle Initial) (Suffix: Jr., etc.) Is this person still living? Yes No Do you live with this person? Yes No Street Address: Apt # City: County: State: Zip: Country: Phone numbers: Preferred Phone (Required): ( ) Preferred Phone Type (Required) (home, work, cell) Alternate Phone: ( ) Alternate Phone Type (home, work, cell) address: Parent/Guardian 2: Relationship to you Name: (Title: Mr. etc.) (Last Name) (First Name) (Middle Initial) (Suffix: Jr., etc.) Is this person still living? Yes No Do you live with this person? Yes No Street Address: Apt # City: County: State: Zip: Country: Phone numbers: Preferred Phone (Required): ( ) Preferred Phone Type (Required) (home, work, cell) Alternate Phone: ( ) Alternate Phone Type (home, work, cell) address: EDUCATIONAL BACKGROUND 20. Are you a: Freshman (no college credit hours) Freshman (with college credit hours) Number of college credit hours earned before high school graduation:
6 21. High school you graduated from or expect to graduate from (Required): (Complete Name of High School) (City) (State) High School Code: (See your high school counselor.) Are you home-schooled? (Response required.) Yes No Date graduated or expect to graduate: MM ( ) YYYY ( ) Do you plan to graduate with an International Baccalaureate (IB) diploma? (Response required.) Yes No Will you graduate from a Texas high school with the Foundation, Recommended or Advanced Program? Yes No If yes, please give the name of the program: 22. If you did not graduate from high school, do you have a GED? Yes No If yes, which test version: English Spanish Date completed: MM ( ) YYYY ( ) In what state did you receive your GED? 23. Please list ALL colleges or universities you have attended or are attending, including college-level correspondence study and dual credit. (Required.) Failure to list all institutions will be considered an intentional omission and may lead to forced withdrawal. Have an official transcript sent to each university to which you apply. (Refer to institution for admissions policy). Name of Institution City and State Dates of Attendance Hours From Through Earned College Code: Please indicate if you have earned or will earn a degree by the time you plan to enroll. Major/Area of Study: Degree Date: Type of Degree: Name of Institution City and State Dates of Attendance Hours From Through Earned College Code: Please indicate if you have earned or will earn a degree by the time you plan to enroll. Major/Area of Study: Degree Date: Type of Degree: Name of Institution City and State Dates of Attendance Hours From Through Earned College Code: Please indicate if you have earned or will earn a degree by the time you plan to enroll. Major/Area of Study: Degree Date: Type of Degree: 24. Are you currently on academic suspension from the last college you attended? yes no REVERSE TRANSCRIPT (Response required.) 25. Do you consent to allow your transcript to be shared with the Texas community college(s) you previously attended for considering eligibility for and awarding of an Associate's degree? Yes No Not applicable - question does not apply to me
7 EDUCATIONAL INFORMATION 26. Indicate semester and year you expect to enter: (example. Fall 2015, Spring 2016) 27. If you plan to pursue a pre-professional program, please specify which one (e.g., pre-law, medicine, nursing, veterinary, physical therapy). 28. Will you seek teacher certification? (Response required.) Yes No If Yes, indicate which level: Elementary Level (Early Childhood-Grade 6) ; Middle School/Junior High Level (Grades 4-8) ; High School Level (Grades 8-12) ; or All-Level (Early Childhood-Grade 12) 29. Senior Course Information List the exact titles of the courses you will complete your senior year. Indicate any Advanced Placement (AP), International Baccalaureate (IB), or dual credit/concurrent enrollment courses and the semester or trimester the course was taken or will be taken. Include college course work, if any, you will complete during your senior year. Dual Credit/ Concurrent Semester or Trimester Senior Courses AP/IB Enrollment 1st 2nd 1st 2nd 3rd TESTS SCORES 30. Please have official test scores sent directly from the testing agency to the colleges and/or universities to which you apply. ACT - Date taken or plan to take: (Month/4-Digit Year) SAT - Date taken or plan to take: (Month/4-Digit Year) TOEFL - Date taken or plan to take (if your native language is not English): (Month/4-Digit Year) IELTS - Date taken or plan to take (if your native language is not English): (Month/4-Digit Year) RESIDENCY INFORMATION (Please answer all questions. Use N/A if the question does not apply to you.) 31. Previous Enrollment: (a) During the 12-month period before you intend to begin classes, did you attend or are you attending a public college or university in Texas in a fall or spring term (excluding summer)? Yes [If yes, complete (b) through (e).] No (If no, skip to question 32.) (b) What Texas public college or university did you last attend? (Give full name, not just initials.) (Residency status is not affected by attending a private college or university.) (c) In which semester were you last enrolled (excluding summer)? Fall 20 Spring 20 (d) During your last semester at a Texas public college or university, did you pay resident (in-state) or nonresident (out-of-state) tuition? Resident (in-state) Nonresident (out-of-state) Unknown
8 (e) If you paid in-state tuition at your last institution, was it because you were classified as a Texas resident or because you were a nonresident who received a waiver? Resident Nonresident with a waiver Unknown 32. Residency Claim: (a) Of what state are you a resident? (b) Did you live or will you have lived in Texas for at least 36 consecutive months before graduating from a public or private Texas high school or completing a GED? (To answer Yes, you must either graduate from a Texas public or private high school, earn or plan to earn a GED, or plan to complete a home-school program. All others must answer No. ) Yes No (c) When you begin the semester for which you are applying, will you have lived in Texas for the previous 12 consecutive months? Yes No If you answered yes to both 32(b) and 32(c), skip to question Basis of Claim to Residency. (If you answered no to any part of question 32, answer the following to assist in determining your residency classification for tuition purposes.) (a) Do you file federal income tax as an independent taxpayer? (An independent taxpayer should not be claimed as a dependent for tax purposes by another person. If you file a joint return with your spouse, answer yes. ) Yes (If yes, continue to question 34.) No (b) Are you claimed or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian? (To be eligible to be claimed as a dependent, your parent or legal guardian must provide at least one half of your support. A stepparent does not qualify as a parent if he or she has not adopted you.) Yes (If yes, skip to question 35.) No (c) If you answered No to both 33(a) and 33(b), who provides the majority of your support? Self (Continue to question 34.) Parent or legal guardian (Skip to question 35.) Other (Skip to question 36, provide an explanation in number 35, and then read and sign number 37.) 34. If you answered Yes to 33(a) or Self to 33(c), answer the following: (a) Are you a U.S. Citizen? Yes No (b) Are you a Permanent Resident of the U.S.? Yes No (c) Are you a foreign national who has submitted an application for Permanent Resident Status to the U.S. Citizenship and Immigration Service (USCIS) and has received a fee/filing receipt or Notice of Action (I-797) from USCIS showing that your I-485 has gone through preliminary review and not been rejected? Yes No (d) Are you a foreign national here with a visa eligible to domicile in the United States or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status? If so, indicate which Visa Status: (e) Do you currently live in Texas? (If you are out of state for a temporary job assignment or for another reason, please answer No and explain in question 36.) Yes No (If no, skip to 36.) (f) (1) If you currently live in Texas, how long have you been living here? Years Months (2) What is your main reason for being in the state? go to college establish/maintain a home work assignment If for reasons other than those listed above, give an explanation in question 36. (g) (1) If you are a member of the U.S. military, is Texas your Home of Record? Yes No (2) What state is listed as your military legal residence for tax purposes on your Leave and Earnings Statement? (h) (1) Do you hold the title (Warranty Deed, Deed of Trust, or other similar instrument that is effective to hold title) to residential real property in Texas? Yes No If yes, date acquired:
9 (2) Do you have ownership interest and customarily manage a business in Texas without the intention of liquidation in the foreseeable future? Yes No If yes, date acquired: (i) (1) For the past consecutive 12 months, have you been gainfully employed in Texas? Yes No (Gainful employment requires an average employment of at least 20 hours per week for one year or earnings equal to at least half of tuition and living expenses for one 9-month academic year. Employment conditioned on student status such as work-study, the receipt of stipends, fellowships or research or teaching assistantships does not constitute gainful employment.) (2) For the past consecutive 12 months, have you received primary support from a social service agency? Yes No (j) Are you married to a person who could answer yes to any part of question (h) or (i)? Yes No If yes, indicate which question could be answered yes by your spouse: How long have you been married to the Texas resident? Years Months If you answered this question (#34), skip question 35 and continue to question If you answered Parent or Legal Guardian to question 33(c), answer the following: (a) Is the parent or legal guardian upon whom you base your claim of residency a U.S. Citizen? Yes No (b) Is the parent or legal guardian upon whom you base your claim of residency a Permanent Resident of the United States of America? Yes No (c) Is this parent or legal guardian a foreign national whose application for Permanent Resident Status has been preliminarily reviewed? (Your parent or legal guardian should have received a fee/filing receipt or Notice of Action (I-797) from U. S. Citizenship and Immigration Services (USCIS) showing the I-485 has been reviewed and has not been rejected.) Yes No (d) Is this parent or legal guardian a foreign national here with a visa eligible to domicile in the United States or a Refugee, Asylee, Parolee or here under Temporary Protective Status? If so, indicate which: (Visa/Status) (e) Does this parent or legal guardian currently live in Texas? (If this parent or legal guardian is out of state due to a temporary job assignment or for another reason, please answer No and explain in question 36.) Yes No (If no, skip to 36.) (f) (1) If your parent or legal guardian is currently living in Texas, how long has he or she been living here? Years Months (2) What is your parent s or legal guardian s main reason for being in the state? Go to college Establish/maintain a home Work assignment If for reasons other than those listed above, give an explanation in question 36. (g) (1) If your parent or legal guardian is a member of the U.S. military, is Texas his or her Home of Record? Yes No (2) What state is listed as your parent s or legal guardian s residence for tax purposes on his or her Leave and Earnings Statement? (h) Does your parent or legal guardian: (1) hold the title (Warranty Deed, Deed of Trust, or other similar instrument that is effective to hold title) to residential real property in Texas? Yes No If yes, date acquired: (2) have ownership interest and customarily manage a business in Texas without the intention of liquidation in the foreseeable future? Yes No If yes, date acquired: (i) For the past 12 consecutive months, has your parent or legal guardian: (1) been gainfully employed in Texas? Yes No (Gainful employment requires an average employment of at least 20 hours per week for one year or earnings equal to at least half of tuition and living expenses for one 9-month academic year. Employment conditioned on student status such as work-study, the receipt of stipends, fellowships or research or teaching assistantships does not constitute gainful employment.) (2) received primary support from a social service agency? Yes No (j) Is your parent or legal guardian married to a person who could answer yes to any part of question (h) or (i)? Yes No If yes, indicate which question could be answered yes by his or her spouse: How long has your parent or legal guardian been married to the Texas resident? Years Months
10 36. General Comments. Provide any additional information that you believe your college or university should know about when evaluating your eligibility to be classified as a resident. 37. All students must read and sign this section. Notification of Rights under Texas Law: Information collected about you through this application may be held by any institution of higher education to which you apply. With few exceptions, you are entitled on your request to be informed about the collected information. Under Sections and of the Texas Government Code, you are entitled to receive and review the information. Under section of the Texas Government Code, you are entitled to correct information held by an institution that is incorrect. You may correct information held by any institution to which you apply by contacting the institution. The information that is collected about you will be retained and maintained as required by Texas records retention laws (Section et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time. The Texas Higher Education Coordinating Board, or its authorized representative(s), has permission to contact you regarding your ApplyTexas application and/or regarding related educational outreach purposes (including, for example, to make you aware of financial aid opportunities) using any of the contact information for communication methods ( , mail, phone, cellular, text message, or automated telephone dialing equipment). Your information will not be sold for commercial purposes. If my application is accepted, I agree to abide by the policies, rules and regulations at any college to which I am admitted. I authorize the college to verify the information I have provided. I certify that the information I have provided is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action. I understand that officials of my college will use the information submitted on this form to determine my status for residency eligibility. I authorize the college to electronically access my records regarding the Texas Success Initiative. I agree to notify the proper officials of the institution of any changes in the information provided. Beginning on January 1, 2012, all entering students are required to show evidence of an initial bacterial meningitis vaccine or a booster dose during the five-year period preceding and at least 10 days prior to the first day of the first semester in which the student initially enrolls at an institution. An entering student includes a first-time student of an institution of higher education or private or independent institution of higher education and includes a transfer student, or a student who previously attended an institution of higher education before January 1, 2012, and who is enrolling in the same or another institution of higher education following a break in enrollment of at least one fall or spring semester.
11 A student is not required to submit evidence of receiving the vaccination against bacterial meningitis if the student meets any of the following criteria: the student is 22 years of age or older by the first day of the start of the semester (effective 1/1/2014); or the student is enrolled only in online or other distance education courses; or the student is enrolled in a continuing education course or program that is less than 360 contact hours, or continuing education corporate training; or the student is enrolled in a dual credit course which is taught at a public or private K-12 facility not located on a higher education institution campus; or the student is incarcerated in a Texas prison. A student is not required to submit evidence of receiving the vaccination against bacterial meningitis if the student submits to the institution: an affidavit or certificate signed by a physician who is duly registered and licensed to practice medicine in the United States, stating that in the physician's opinion, the vaccination would be injurious to the health and well-being of the student; or an affidavit signed by the student stating that the student declines the vaccination for reasons of conscience, including a religious belief. A conscientious exemption form from the Texas Department of State Health Services must be used; or confirmation that the student has completed the Internet-based Department of State Health Services form to claim an exemption for reasons of conscience (for entering students at community and technical colleges ONLY). Information about requesting the affidavit form from DSHS is found at https://corequest.dshs.texas.gov/. The DSHS form may be ordered electronically; however they will be mailed to the address provided by the student. Please allow up to two weeks to receive the form. For Public Junior College Students only: to access the DSHS secure on-line exemption form click here: https://corequestjc.dshs.texas.gov/ A copy of the form must be submitted to the designated school official at the institution the student will be attending. Signature: Date:
12 PART II. EXTRACURRICULAR AND VOLUNTEER ACTIVITIES See General Application Information to determine if this part is required for your application to the institution(s) of your choice. Please list, in priority order, the organizations, activities, jobs, and internships that indicate your special contributions, talents, honors, and abilities in the areas of extracurricular activities, service and work. Include service and work done in the summer. Please spell out the names and describe the organizations in which you have participated. You may attach additional pages if needed. In addition, you may also attach a résumé. Résumé attached: Yes No Extracurricular Activities Organization Examples: Speech/Debate Club Extemporaneous Speaking Your Position/Year Examples: Committee Chair/senior Captain/junior Were you elected to this position? (circle Yes or No) Level Examples Regional Local Description of Activities Examples: Hosted Speech Tournament Played Forward Hours Per Week/Hours Per Year (3/32 = three hours per week/32 weeks per year) Fresh. 3/32 5/16 Soph. 3/32 5/16 Jr. 6/32 Sr. 6/32 Community or Volunteer Service Service/Volunteer Work Examples: Habitat for Humanity Hospital Volunteer Description of Service Examples: Helped build houses Helped nurses and visited patients From-Through 5/11-5/12 6/12-8/12 Total Hours
13 Talents/Awards/Honors Talent/Award/Honor Examples: Voice Regional Qualifier (Speech) All-State Basketball Team Description Examples: Sang in school choir 1 of 3 chosen for regional team (UIL) 1 of 5 in state chosen for first team Level Examples: Regional State Year Received Fresh. Soph. Jr. Sr. X X X X X X X Employment/Internships/Summer Activities Name of Employer/Sponsor Examples: Grocery Store Exchange Program Your Specific Role/Job Title Examples: Sacker: Sacked groceries, helped customers Spent two months with host family in Spain From-Through 6/14-9/15 6/14-7/14 Hours Per Week 10 n/a
14 Essays Institutions do not require all four essays. See General Application Information to determine if you are required to write an essay or essays as part of your application for admission. Unless otherwise specified, your essay(s) should be typed and be no longer than one page (8 1/2 x 11 ). Please put your name and Social Security number at the top of each page. Topic A. Describe a setting in which you have collaborated or interacted with people whose experiences and/or beliefs differ from yours. Address your initial feelings, and how those feelings were or were not changed by this experience. Topic B. Describe a circumstance, obstacle or conflict in your life, and the skills and resources you used to resolve it. Did it change you? If so, how? Topic C. Considering your lifetime goals, discuss how your current and future academic and extra-curricular activities might help you achieve your goals. Topic D. The essay in this section is specific to certain institutions and majors. It is not required by most colleges/universities that accept the ApplyTexas Application. Please see the General Application Information. Personal interaction with objects, images and spaces can be so powerful as to change the way one thinks about particular issues or topics. For your intended area of study (architecture, art history, design, studio art, visual art studies/art education), describe an experience where instruction in that area or your personal interaction with an object, image or space effected type of change in your thinking. What did you do to act upon your new thinking and what have you done to prepare yourself for further study in this area? Application Fee Application fees are listed in the General Application Information. Include the student s name and Application ID number on your check or money order. Check the website of the institution(s) to which you are applying to see if credit card payment of the application fee is also accepted. Students with financial need should check with their high school counselor or the institution(s) to which they are applying for information concerning a possible waiver of the application fee (i.e., college application fee waiver).
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Application for Undergraduate Admission 471 University Parkway Aiken, SC 29801 803-641-3366 E-mail: firstname.lastname@example.org Website: www.usca.edu/admissions Please read all instructions and additional notes before
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Health Care Compliance Certificate The Health Care Compliance Certificate provides the unique skills needed to guide a health care organization through the complex maze of government laws and regulations.
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Undergraduate Application University of South Carolina Upstate 800 University Way u Spartanburg, SC 29303 864-503-5246 u 1-800-277-8727 Fax: 864-503-5727 E-Mail: email@example.com www.uscupstate.edu
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City of Novato Employment Application Human Resources Office 922 Machin Avenue Novato, California 94945 415/899-8900 Instructions: Print or type requested information using black or dark blue ink. Immediately
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