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APPLICATION FOR ADMISSION

1. Name and Address


Student Name  
Last Name:
First Name:
Middle Name:
Suffix:
   
Have you ever been enrolled in school under any other name(s)? Yes   No
Last Name:
First Name:
Middle Name:
   
Last Name:
First Name:
Middle Name:
   
Permanent Address  
Street:
City:
County:
State:
Zip Code:
Country:
International Postal Code:
   
Mailing Address (if different)  
Street:
City:
County:
State:
Zip Code:
Country:
International Postal Code:
   
   
Contact Information  
Home Telephone:
Cell Phone Number:

2. Personal Information


Applicant Information  
Gender: Male   Female
   
Are you Hispanic/Latino? Yes   No
   
Please check one or more: American Indian/Native Alaskan
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White  
   
With what race or ethnicity do you most closely identify with? American Indian or Alaskan Native
Asian or Pacific Islander
Black (not of Hispanic origin)
Hispanic
White (not of Hispanic origin)
   
Have you served or are you currently serving in the U.S. Armed Services? Yes   No
   
These questions are strictly optional and will in now way affect the decision of whether to admit any applicant. Shepherd University requests that these questions be completed to assist the college in complying with its obligations under state and federal law to attempt to collect this data and to periodically report the statistical totals in various reports, including the annual EEO/AA Plan published by the Affirmative Action Officer.
   
   
Citizenship Information  
Are you a citizen of the United States? Yes   No
If not, what type of visa immigration status do you hold?
Visa or permanent resident number:
Miscellaneous Information  
Have you been convicted of any offense other than a misdemeanor or minor traffic violation? Yes   No
If yes, please explain:
Parent/Legal Guardian Information  
   
Mother's Information  
First Name:
Middle Name:
Last Name:
Street:
City:
U.S. State/Territory:
Zip Code:
Country:
International Postal Code:
   
Father's Information  
First Name:
Middle Name:
Last Name:
Street:
City:
U.S. State/Territory:
Zip Code:
Country:
International Postal Code:
   
Legal Guardian's Information  
First Name:
Middle Name:
Last Name:
Street:
City:
U.S. State/Territory:
Zip Code:
Country:
International Postal Code:
   
   
Check here if you are a first generation student (neither of your parents/guardians with whom you reside has completed a four-year college degree)
   
Emergency Contact Information  
   
First Name:
Middle Name:
Last Name:
Relationship:
Street:
City:
U.S. State/Territory:
Zip Code:
Country:
   

3. Enrollment Information


Enrollment Information  
I wish to apply for: Spring 2013   Summer 2013   Fall 2013
   
Please check all that apply: Freshman
Early Admissions
Honors Program
Readmit (Semester and year last enrolled )
Transfer
Transient
   
My college housing plans are: On-campus   Off-campus  
   
Please note that all full-time, single, unmarried students who do not have dependents are required to live on campus unless they commute from home (living with parent or legal guardian). Parent or legal guardian homes from the following counties are considered to be within appropriate commuting distance: Jefferson and Berkeley Counties of West Virginia; Frederick and Washington Counties of Maryland; and Frederick, Clarke, and Loudon (excluding the cities of Ashburn and Sterling) Counties of Virginia.
   
Do you already hold a baccalaureate degree? Yes   No
   
Intended Major:
   
Additional Information  
If a West Virginia resident, how long have you (and/or your parent or guardian) lived in West Virginia?

4. High School Information


High School Information

All applicants must complete this section: freshmen, transfers, readmits, and specials. Please arrange to have an official high school transcript and ACT or SAT scores forwarded to the Office of Admissions if you are applying as a first-time freshman or as a transfer applicant with less than fifteen semester hours of college credit.

   
High School:
City:
U.S. State/Territory:
Zip Code:
Country:
Date of Graduation: mm/dd/yyyy
   
Test Information  
I have taken or plan to take the SAT on: mm/dd/yyyy
I have taken or plan to take the ACT on: mm/dd/yyyy
I have taken or plan to take the TOEFL on: mm/dd/yyyy
I took the GED in: mm/dd/yyyy

5. College Information


College Information

All transfer applicants--including high school students who have taken college classes--must complete this section. Transfer students must have two (2) official transcripts sent to the Office of Admissions from each college previously attended. Incomplete information may result in disciplinary action or denial of admission.

Have you been or are you presently enrolled in any college or university? Yes   No

List all colleges you have attended and the hours/degrees earned, beginning with the most recent:

   
College/University:
City:
U.S. State/Territory:
Zip Code:
Country:
   
College/University:
City:
U.S. State/Territory:
Zip Code:
Country:
   
College/University:
City:
U.S. State/Territory:
Zip Code:
Country:
   
College/University:
City:
U.S. State/Territory:
Zip Code:
Country:

Miscellaneous Information

Have you been suspended or expelled for academic or disciplinary reasons? Yes   No
If you have, are you currently eligible to return to that institution? Yes   No
If yes, briefly explain the nature of suspension or expulsion:

   
I certify that all statements in this application are complete and true. I understand that any willful misrepresentation of information may be grounds for denial of my admission and dismissal. Yes   No

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Shepherd University | Office of Admissions | P.O. Box 3210 | Shepherdstown, WV | 25443-3210 | 304-876-5212 | 800-344-5231 | FAX 304-876-5165 | E-Mail: admissions@shepherd.edu