Undergraduate Application

U NIVERSITY OF Y OF M ASSACHUSETTS B OSTON Undergraduate Application 11.13.13 Section I: Applicant s Personal Information LEGAL NAME: Last/Family/Sur (Enter exactly as it appears on official documents.) First/Given Middle Jr., etc. PREFERRED NAME, if not first name (only one) FORMER LAST NAME(S) DATE of BIRTH: Female Male US Social Security Number (if any) mm/dd/yyyy (Required for US Citizens & Permanent Residents applying for financial aid via FAFSA) PREFERRED TELEPHONE: HOME ( ) CELL ( ) E-MAIL ADDRESS: PERMANENT HOME ADDRESS: number & street apartment number city/town county/parish state/province country zip/postal code If different from above, please give your current mailing address for all admissions correspondence. CURRENT MAILING ADDRESS: number & street apartment number city/town county/parish state/province country zip/postal code If your current mailing address is a boarding school, include name of school here: _ Section II: Demographic Information Please describe your US citizenship status. US Citizen Permanent Resident (provide Registration number): Deferred Action for Childhood Arrivals (documentation must include copy of Employment Authorization card) Non-US Citizen (indicate country of citizenship): If you plan to apply for a student visa, please indicate your intended visa status. VISA TYPE: F1 F2 J1 J2 Place of Birth: city/town state/province country Years lived in US? Years lived outside the US? Language Proficiency (Please check all that apply.) [S=speak; R = Read; W = Write; F = 1 st language; H = spoken at home] Language S R W F H 1. 2. 3.

Answering the following 3 items is optional. No information you provide will be used in a discriminatory manner. 1. Please clarify your status relative to the US Armed Forces -- check everything that applies: Active Military National Guard Active Reserve Inactive Reserve Dependent Veteran Combat Veteran Massachusetts Veteran No status Disabled Massachusetts Veteran Disabled Non-Massachusetts Veteran 2. Are you Hispanic/Latino? Yes, Hispanic or Latino (including Spain) No If yes, please describe your background. 3. Regardless of your answer to the previous question, please indicate how you identify yourself by checking one or more of the following, 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 the Indian subcontinent and the Philippines) Black or African American (including Africa and the Caribbean) Native Hawaiian or Other Pacific Islander (Original Peoples) White (including Middle Eastern) Section III: Admit Term & Financial Aid Please note the following application deadlines: Fall Semester Deadline: (domestic and international freshmen) (international and domestic transfer students, nursing BS for RNs) (computer engineering, electrical engineering, nursing BS) April 1 June 15 February 1 Spring Semester Deadlines Summer Deadline: (domestic freshmen and transfer students) (electrical engineering, nursing BS for RNs) (international freshmen and transfer students) (nursing BS accelerated program) December 15 November 1 December 1 November 1 st In which semester/term do you plan to begin attending UMass Boston? Fall (starts in September) Spring (starts in January) Summer (starts in May; accelerated nursing program only)... Admit Type: Freshman Transfer MassTransfer Do you intend to apply for need-based financial aid?* Yes No... * (International students are not eligible to receive financial aid.)

Section IV: Enrollment Plans Please refer to the list of majors below and indicate your preferred majors here. Be sure to select the appropriate degree type for your chosen majors (BA or BS) and select your first choice. Please also indicate a second choice major in the space provided. First Choice: (Choose from the list below Check one.) Second Choice: (Please hand print.) Africana Studies BA Italian BA American Studies BA Latin American and Iberian Studies (Spanish) BA Anthropology BA Management BS Anthropology & History BA Accounting Art BA Finance Asian Studies BA International Management Biochemistry BS Leadership & Organizational Change Biology BS Management Information Systems Chemistry BS Marketing Classical Languages BA Supply Chain & Service Management Classical Studies BA Undecided Communications BA Mathematics BA Computer Engineering BS Mathematics BS Computer Science BA Music BA Computer Science BS Nursing BS Criminal Justice BA Nursing BS Accelerated Program prior BA/BS required Early Education and Care in Inclusive Settings BA Nursing BS for RNs online program Economics BA Nursing BS for RNs Cape Cod English BA Philosophy BA Electrical Engineering BS Philosophy and Public Policy BA Engineering Physics BS Physics BS Environmental Sciences BA Political Science BA Environmental Sciences BS Psychology BA Ethics, Social and Political Philosophy BA Psychology BS Exercise and Health Sciences BS Psychology and Sociology BA French BA Sociology BA History BA Theatre Arts BA Human Services BA Undecided Liberal Arts Information Technology Science & Mathematics BS Undecided Science and Mathematics Information Technology Management BS Women s Studies BA If you are applying through the New England Regional Student Program (NERSP), please check this box and write in your NERSP major of choice. SECTION V: Education Most recent school attended: Entry Date: Graduation Date (or anticipated completion date): Address: number and street City/town state/province country ZIP/postal code Counselor/Advisor Name: Title: E-mail: Telephone: ( ) FAX: ( ) Other Schools/Colleges attended: School Name Location (city, state, ZIP, country) Dates Attended Degree

Please check this box if you have a disability and believe that SAT I or ACT scores are not, therefore, an appropriate measure of your capacity for college-level work, and you wish to request a waiver of the requirement to submit these scores. Your voluntary response will be kept confidential, and will have no bearing on the University s admission decision. You must also submit documentation of the diagnosis of your disability from a qualified medical professional. The University of Massachusetts Boston may require an alternative mode of assessment in lieu of SAT I or ACT scores. SECTION VI - Academics Self-reported information in this section does not take the place of official records. Please be sure to have official transcripts sent, as required, from all secondary schools or institutions of higher learning attended, along with any necessary test scores from the appropriate testing agencies. ACT Scores Exam Dates: Best Scores: mm/yyyy COMP mm/yyyy English mm/yyyy Math mm/yyyy Reading mm/yyyy Science mm/yyyy Writing mm/yyyy SAT I Scores Exam Dates: Best Scores: mm/yyyy Crit. Reading mm/yyyy Math mm/yyyy Writing mm/yyyy TOEFL/IELTS Exam Dates: Best Score: mm/yyyy Test Score mm/yyyy TEAS Scores* Exam Dates: Percentage (%) Score: mm/yyyy Reading Math Science English Total % * for students transferring into our nursing or accelerated nursing programs Current Courses: Please indicate title, level (AP, IB, advanced honors, numerical level, etc.) and credit value of any courses you are currently taking, or for which you expect to receive grades post-application but prior to starting at UMass Boston. SECTION VII - Writing TRANSFER STUDENTS Please provide a statement that addresses your reasons for transferring and the objectives you hope to achieve at UMass Boston. (250 650 words) FRESHMEN The essay demonstrates your ability to write clearly and concisely on a selected topic, and helps you distinguish yourself in your own voice. What do you want the readers of your application to know about you, apart from courses, grades, and test scores? Choose the option below that best helps you answer that question, and write an essay of no more than 650 words, using the prompt to inspire and help you structure your response. Remember: 650 words is your limit, not your goal. Use the full range if you need it, but don t feel obligated to do so. Some students have a background or story that is so central to their identity that they believe their application would be incomplete without it. If this sounds like you, please share your story. Recount an incident or time when you experienced failure. How did it affect you, and what lessons did you learn? Reflect on a time when you challenged a belief or idea. What prompted you to act? Would you make the same decision again? Describe a place or environment where you are perfectly content. What do you do or experience there, and why is it meaningful to you? Discuss an accomplishment or event, formal or informal, which marked your transition from childhood to adulthood within your culture, community, or family.

SECTION VIII: Family Information Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Even if you are an adult or emancipated minor, this information is used for demographic and statistical purposes. If you are a minor with a legal guardian (an individual or government entity), then please list that information, as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, on a separate sheet. Parent 1: Mother Father Unknown Is parent 1 living? Yes No (date deceased: ) mm/yyyy Name: Last/Family/Sur First/Given Title(Mr./Mrs./Ms./Dr.) Country of Birth: Home Address, if different from yours: Preferred Telephone: Home Cell Work E-mail: Occupation: Employer: College (if any): Grad School (if any): Legal Guardian: (if other than parent) Relationship to you: NAME: Last/Family/Sur First/Given Title(Mr./Mrs./Ms./Dr.) Country of Birth: Home Address, if different from yours: Preferred Telephone: Home Cell Work ( ) E-mail: Occupation: Employer: College (if any): CEEB: Grad School (if any): CEEB: Parent 2: Mother Father Unknown Is parent 2 living? Yes No (date deceased: ) mm/yyyy) Name: Last/Family/Sur First/Given Title(Mr./Mrs./Ms./Dr.) Country of Birth: Home Address, if different from yours: Preferred Telephone: Home Cell Work ( ) E-mail: Occupation: Employer: College (if any): Grad School (if any): Siblings: Please give names and ages of your brothers and sisters. If they are enrolled in grades K-12 (or international equivalent), list their grade levels. If they have attended or are attending college, give the names of their undergraduate institution, degree earned, and approximate dates of attendance. If more than two siblings, please list them on a separate sheet. 1. Name Age & Grade Relationship College Attended: CEEB: Degree earned or expected: Dates of attendance: 2. Name Age & Grade Relationship College Attended: CEEB: Degree earned or expected: Dates of attendance: SECTION IX: Additional Information Did you participate in a Massachusetts high school Dual Enrollment program? Yes No Are you interested in the UMass Boston Honors Program? Yes No Have you previously taken courses at UMass Boston? Yes No

SECTION X: Residency Information For the purpose of assessing tuition and fees, each student shall be classified as a Massachusetts resident or a Non-Massachusetts resident. A person shall be classified as a Massachusetts resident if he/she (or the parent of a non-emancipated student) shall have resided in the Commonwealth of Massachusetts for purposes other than attending an educational institution for twelve months immediately preceding entry or re-entry as a student. Physical presence for the entire twelve-month period need not be required as long as the conduct of the individual, taken in total, manifests an intention to make Massachusetts his/her permanent dwelling place. International Students are not considered Massachusetts residents. After reading the rules and regulations governing residency status for tuition purposes at the University of Massachusetts Boston, please indicate whether you DO or DO NOT qualify as a Massachusetts resident by checking the appropriate box below and indicating residency start date, if applicable (check one only): I do not qualify for classification as a Massachusetts resident. I am an international student who requires a visa to study in the US. I have been a legal resident of CT, ME, NH, RI or VT for at least the past year. I am 18 years of age or more, and have resided continuously in Massachusetts since -. month year I am under 18 years of age and my parent(s) or guardian has/have resided continuously in Massachusetts since -. month year I am married and my spouse has resided continuously in Massachusetts since -. (Please provide a copy of your marriage certificate and spouse s MA tax form from last year.) month year SECTION XI: Disciplinary History 1. Have you ever been found responsible for a disciplinary violation at any educational institution you have attended since 9 th grade (or international equivalent), whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? Such actions might include, but are not limited to: probation, suspension, removal, dismissal or expulsion from the institution. Yes No 2. 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 of the above questions, please provide a statement below or on a separate sheet of paper giving the approximate date of each incident, explaining the circumstances, and reflecting on what you learned from the experience(s).

SECTION XII: Signatures Financial Aid NOTE: The University of Massachusetts awards millions of dollars each year in federal, state and institutional financial aid, including grants and lowinterest student loans to eligible students. Many students, however, miss out because they think they are not eligible and do not complete the Free Application for Federal Student Aid (FAFSA). To apply for federal and state financial aid, students must complete the FAFSA, which is available at the Federal Financial Aid website; www.fafsa.ed.gov. Financial Aid can be used to pay for tuition, fees, books, transportation, and other educational expenses. We strongly encourage you to complete and submit the FAFSA. If you need help with your financial aid application or college financial planning, our Financial Aid Office has counselors who can assist you. Application Fee & Payment In-State and Out-of-State Applicants $ 60.00 International Applicants $ 100.00 How will you pay the application fee? Check or Money Order enclosed Fee Waiver Signature: Please sign below. * If you are under 18 years of age, a parent or guardian must also sign. I certify that the information provided on this form about my residency is accurate and true. I understand that not completing the residency section of this supplement and providing the required documentation means that I will be classified and billed as an out-of-state student. I certify that all information submitted in the application process including this application document, the personal essay, any supplements and other supporting materials is my own work, factually true, and honestly presented, and that these documents will become the property of the University of Massachusetts, 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 hereby be proven false. Should there be any changes in the substance of the information given herein, I will immediately notify the University of Massachusetts Boston s Office of Undergraduate Admissions. I acknowledge that any offer of admission is 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 my previous institution(s). I affirm that I will send an enrollment deposit in a timely way to ensure my admittance and enrollment intent, or notify the University of Massachusetts Boston Office of Undergraduate Admissions of my intent to enroll elsewhere. Signature of Applicant Signature of Parent or Guardian Date Date