Application for International Admission $100 Application Fee. Nonrefundable. Please type or print clearly and fill in all blanks.
LEGAL NAME ______________________________________________________________________________________________________________________________
Last
First
Middle
Preferred
PERMANENT ADDRESS ______________________________________________________________________________________________________________________________
Street
City
providence/territory
postal code
Country
MAILING ADDRESS ______________________________________________________________________________________________________________________________
Street
City
providence/territory
postal code
Country
Country of Birth ___________________________________________________________
Country of citizenship __________________________________________________________
Home PHONE ( ) - ___________________________________________________________
CELL Phone ( ) - __________________________________________________________
E-MAIL ADDRESs _______________________________________________________________________________
DATE OF BIRTH / / ____________________________________________
Month
Day
Year
Responses to the following questions are voluntar y and will be k ept confidential. Failure to provide this information will not affect the status of this application. Please check the appropriate answer. GENDER
Female
Male
MARITAL STATUS
Divorced
Married
Separated
Single
Widowed
select one or more of the following racial categories to describe yourself: American Indian or Alaska Native
Asian
Black or African American
Yes
ETHNICIT Y: Do you consider yourself to be Hispanic/Latino?
No
Native Hawaiian or Pacific Islander
RELIGIOUS AFFILIATION ______________________________________________________
HIGH SCHOOL __________________________________________________________________________________
Name
City
White
State
Graduation Date / ________________________________________ Month
Year
List all previously attended colleges or universities, star ting with the most recent. Include attendance at D elta State.
College Name
City and State
Dates of Attendance
Degree Earned
1 ______________________________________________________________________________________________________________________________ 2 ______________________________________________________________________________________________________________________________ 3 ______________________________________________________________________________________________________________________________
WHEN DO YOU PLAN TO ENTER DELTA STATE UNIVERSIT Y? Fall 20________
Spring 20________
Degree Seeking?
Yes
No
WHAT UNDERGRADUATE CLASSIFICATION DO YOU EXPECT TO HAVE WHEN YOU ENROLL? (Semester Hours Passed–SHP) Freshman (0–29 SHP)
Sophomore (30–59 SHP)
Junior (60–89 SHP)
Signature Required On Back
Senior (90–OVER SHP)