EMU Exchange Program

C E N T R A L S T A T E

C O N N E C T I C U T U N I V E R S I T Y

Please mail to: Office of Recruitment and Admissions Central Connecticut State University PO BOX 4010 1615 Stanley Street New Britain, CT 06050-4010 CCSU’s Toll-free number (in CT) 1-888-733-2278 or (860) 832-CCSU (2278) e-mail: admissions@ccsu.edu www.ccsu.edu

Name (last, first, m.i.)

Application for Undergraduate Admission

PLEASE DO NOT write below this line.

OFFICE USE ONLY Information Requested Date ___________________________________________________________ SPECIAL NOTES FOR EXCHANGE STUDENTS: ___________________________________________________________ Forward all application materials to the CCSU ___________________________________________________________ Center for International Education through your ___________________________________________________________ Home University. ___________________________________________________________ $40 Application fee does not apply. ___________________________________________________________ ___________________________________________________________

Date____________________________________ ________________Fall _______________Spring CPA ____________________________________ Sem Hr _________________________________ Rank/SAT _______________________________ Lang Req________________________________

___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Action ______________________________________________________ ___________________________________________________________

Social Security Number

Comments __________________________________________________

Congratulations!

Congratulations on your decision to apply to Central Connecticut State University.

Help us make the right decision by telling us more about you. Far too often prospective students sell themselves short on a one-page application. We want to take into consideration all aspects of your background. It is important to remember that CCSU’s application gives you an opportunity to talk about your academic achievements, awards, work history, and leadership activities.

We encourage you to visit us through our web site at www.CCSU.edu, apply on the Web, or come in and take a tour of our campus. We want to help make your dream become a reality.

How to Apply Please complete every question. If you are unsure how to answer, please refer to the detailed Admissions Information and Instructions located below. We will be happy to answer any additional questions. Kindly call the Office of Recruitment and Admissions at (860) 832-2278.

Admissions Information and Instructions Applicable To All Applicants All materials requested should be sent directly to the Office of Recruitment and Admissions at CCSU by the high school or the College Registrar’s office. Unofficial or student copies will not be accepted.

The information furnished by you on your Application for Admission, together with all other information and materials received by the Office of Recruitment and Admissions from any source, will be kept completely confidential. It will not be disclosed to anyone, except that the Director of Recruitment and Admissions may, for official purposes only, release information according to the provisions of the Family Educational Rights and Privacy Act of 1974.

A non-refundable application fee of $40 must accompany your application. Make check or money order payable to Central Connecticut State University. Your cancelled check or money order is your receipt. We also accept Visa, Master or Discovery cards. Please see payment form on page 9, and include your application fee with this application.

First Year (Freshman) Applicants • Any first year student should submit an official high school transcript including latest class rank, first quarter or midyear grades, SAT I scores and any other standardized test results (ACT, TOEFL), personal statement and recommendations.

• First year applicants should give their completed application and check for $40 to the director of guidance who should forward the completed application to the Office of Recruitment and Admissions.

• Final high school transcript must be submitted upon graduation.

• The University requires that only first year applicants submit scores from the Scholastic Assessment Tests (SAT I). You should request that the results be sent to CCSU. All necessary information about the SAT I may be obtained from any high school guidance office. The University also recognizes scores from the American College Testing (ACT).

• If you did not graduate from high school, you must submit a copy of your General Equivalency Diploma (GED) test results. Applicants should also request that their former high school send a transcript. Please contact your State Department of Education for GED information.

• Applications must be complete and received by the Office of Recruitment and Admission no later than August 1 for the Fall Semester and December 1 for the Spring Semester.

Transfer Students • Any student transferring from a regionally accredited, post-secondary institution must submit an official transcript from each institution attended.

• Transfer applicants must also submit an official final high school transcript or a copy of GED diploma.

• Transfer students may submit their completed application directly to the Office of Recruitment and Admissions.

• Failure to list all colleges on the application or to provide said transcripts from each institution may be considered sufficient reason for refusal of admission or subsequent dismissal from the University.

• Applications must be complete and received by the Office of Recruitment and Admission no later than August 1 for the Fall Semester and December 1 for the Spring Semester.

International Students The Office of Recruitment and Admissions requires additional credentials for international applicants. Deadlines for applying are April 1 for the Fall Semester and November 1 for the Spring Semester.

International applicants must submit: • A completed application and application fee. U.S. money orders, U.S Postal money orders and checks drawn from a U.S. bank with the checking account number listed on the check are accepted. Visa, Master and Discovery cards are also accepted.

• Official/Certified Transcripts of secondary schooling and post secondary (college) schooling (if attended). Documents are considered official when they are sent directly to CCSU by the educational institution or issuing board. If the documents are not in English, certified English translations must also be provided. If course work was completed at a U.S. college, official transcripts must be sent from each institution attended.

• CCSU requires an Affidavit of Support verifying that your Sponsor will provide the Estimated Expenses in U.S. dollars to you for each calendar year of study at CCSU. The Affidavit of Support may be obtained from the CCSU Center for International Education, 1615 Stanley Street, New Britain CT, 06050. Completed and dated within six to nine months of intended entry into CCSU. • International students currently attending institutions (college or high school) within the U.S. must also submit a copy of their current I-20 form to the Center for International Education, 1615 Stanley Street, New Britain CT, 06050.

Admissions Policy Admission to Central Connecticut State University depends upon the academic credentials presented by the applicant. No applicant is rejected because of race, color, religious belief, or national origin. The University does not discriminate in access to, or treatment of, or employment in its programs and activities of qualified handicapped persons defined under the provisions of the Rehabilitation Act of 1973. The University’s nondiscrimination opportunity policies extend to employment practices, admissions of students, programs, and services within the institution or provided to the community.

Campus Safety Statement In accordance with the State of Connecticut’s Campus Safety Act (PA 90-259), Central Connecticut State University will provide a copy of the Uniform Campus Crime Report to any individual who sends a written request to: Central Connecticut State University, Police Department, P.O. Box 4010, New Britain, CT 06050-4010.

SPECIAL NOTES FOR EXCHANGE STUDENTS: Forward all application materials to the CCSU Center for International Education through your Home University.

1 $40 Application fee does not apply.

General Information (Please type or print clearly in ink) Name (Mr./Ms.) ________________________________________________________________________________________________________ Last First Middle Social Security Number _________-______-_________

Prefer to be called (nickname) __________________________________________

List other names that your records may be found under (i.e., maiden) ___________________________________________________________ Permanent Home Address

____________________________________________________________________________________________ Number and street City State Zip Code

Mailing Address (if different) ______________________________________________________________________________________________ Number and street City State Zip Code Telephone Number (_____)_______________(_____)_____________________ E-Mail Address _______________________________________ Home Work

Educational Data (High School Information) Name of High School ___________________________________________________________________________________________________ High School Address ___________________________________________________________________________________________________ Month/year of high school graduation _______/_______ Month year School telephone (_____)___________________

If you have a General Equivalency Diploma (GED), issued date________ /_________ Month year If applicable: High School Counselor Mr./Ms._________________________________

❑ Method of Education if different from traditional education ______________________________________________________________ (Type of schooling) Is this method of education Board of Education approved? ❑ Yes ❑ No ___________________________________ ____________________ City State When did you or will you take the SAT or the ACT exam? ______ /_____, ______ /______ If you took the TOEFL, when ______ /______ have official TOEFL score sent to Month year Month year Month year (Please Admissions Office. For non-native speakers only)

Higher Education Data (Colleges/Universities) List all colleges at which you have enrolled, even if no courses were completed. List the most recent first, followed by previous, then the next most recent, etc. Please have an official transcript from each institution sent to CCSU’s Office of Recruitment and Admissions as soon as possible. Failure to list all colleges on the application or to provide said transcripts from each institution may be considered sufficient reason for refusal of admission or subsequent dismissal from the University.

College Dates of Attendance Degree Awarded Type From To 2/4 year Month/year Month/year Degree Month/year _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Name of College or University

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Location City/State

General Semester Information (Please type or print clearly in ink) Admission requested for ❑ Fall ❑ Spring

Expect to attend ❑ Full-time ❑ Part-time

Year ________

Type of applicant ❑ First Year ❑ Transfer ❑ CCSU non-matriculated student (Currently or previously attended CCSU as a non-matriculated student) ❑ Re-entry (previously attended CCSU as a matriculated student) If Re-entry, dates of attendance ______________________________ Financial Aid Requested ❑ Yes ❑ No

On Campus Housing Requested

❑ Yes ❑ No

Special Program interest Interested in Honors Program ❑ Yes ❑ No (Open to academically superior students who meet any one of the following qualifications:Top 20% of class, 1100+ combined SAT scores, or Verbal SAT of 600+) Interested in going into medicine, dentistry, veterinary medicine, podiatry, etc. ❑ Yes ❑ No (For more information visit our web page at www.prehealth.ccsu.edu/)

Personal Data Date of Birth ______ / ______ / _____ Month Day Year

❑ Female ❑ Male

Age ____

Religion ______________________________________________ (Optional for Campus Ministry)

Ethnic Origin (NOTE: This information is for statistical purposes. Admission to a campus of the Connecticut State University is based on the applicant without regard to sex, creed, national origin, or disability. Please complete this section if you wish to be considered for any benefits that may be available to members of a racial group under-represented in higher education.)

❑ African-American ❑ Asian or Pacific Islander ❑ Black (non African-American) ❑ Hispanic/Latino (non Puerto Rican) ❑ Native American ❑ Puerto Rican ❑ White ❑ Other _______________________________ ❑ Prefer Not to Respond Essentially, Public Act 73-474, C.G.S., Sec 10A-29 specifies that the residence of an unemancipated person is that of his or her parent. In addition, it specifies that one must maintain a clearly established residence in Connecticut for at least one year to establish a new legal residence: that an emancipated person who can provide evidence of permanent residence in Connecticut is eligible for classification as an in-state student for tuition purposes; and makes certain provisions for special cases.

ARE YOU A U.S. CITIZEN? ❑ Yes ❑ No

IF YES, YEARS IN USA _________

ARE YOU A "LEGAL RESIDENT" OF CONNECTICUT? ❑ Yes ❑ No

IF YES, YEARS IN CONNECTICUT _________

IF YOU ARE NOT A U.S. CITIZEN, PLEASE COMPLETE THIS SECTION: COUNTRY OF CITIZENSHIP _______________ ARE YOU IN THE USA NOW? ❑ Yes ❑ No Student Visa Sought:

IF YES, VISA TYPE: __________________

❑ F-1 ❑ F-2 ❑ J-1 ❑ J-2

❑ Permanent resident with alien registration card

Alien number __________________________

(Please send a photocopy of front and back of alien card or Proof of Eligible Non-citizenship.)

Statements of Applicant and Parent or Guardian If admitted, I pledge myself to comply, in good faith, with all the rules and regulations of the University. I realize that any misleading information given by me on this application may cause my dismissal.

Date _______________ Signature of applicant _______________________________________________________________ This application is made with my consent. (Required if applicant is under 18 years old) Date _______________ Signature of parent/guardian _______________________________ Relationship ________________ 3

Academic Programs:

See catalog for detailed information on academic programs

Please check one major and a specialization(*) where applicable ❐ Mathematics+ ❐ Actuarial Science* ❐ Operations Research* BA Degree ❐ Statistics* Majors and Specializations: ■ Music+ ❐ Anthropology ❐ History* ■ Art + ❐ Jazz Studies* ❐ Art history* ❐ Performance* ❐ Ceramics* ❐ Theory & Composition* ❐ Design/Graphic Design* ❐ Philosophy+ ❐ Illustration* ❐ African, African-American, & ❐ Media Arts Asian Philosophy* ❐ Painting* ❐ Continental Philosophy* ❐ Printmaking* ❐ History of Western ❐ Sculpture* Philosophy* ❐ Communication+ ❐ Logic & Philosophy of ❐ Advertising* Science* ❐ Philosophy of Religion & ❐ Mass Media* Religious Studies* ❐ Organizational Communication* ❐ Political Science+ ❐ Political Communication* ❐ Public Administration* ❐ Promotion/Public Relations* ❐ Psychology+ ❐ Criminology ❐ Social Work ❐ Design (Graphic/Information) ❐ Sociology ❐ Economics ❐ Spanish ❐ Operations Research* ❐ Theatre+ ❐ English

SCHOOL OF ARTS & SCIENCES

❐ French ■ Geography+ ❐ Environmental* ❐ Planning* ❐ Regional* ❐ Techniques* ❐ Tourism* ❐ German ❐ History ❐ Interdisciplinary Science: Computer Science ❐ International Studies ❐ Italian + Major * Specialization

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BFA Degree Majors & Specializations: ■ Theatre+ ❐ Acting* ❐ Design/Tech. Theatre* ❐ General* ❐ General/Dance* ❐ Undeclared (for students

interested in majoring in Theatre but unsure of the specialization)

BS Degree (Non-Teaching) Majors: ❐ Biology+ ❐ Cell, Molecular, Physiological* ❐ Ecology, Biodiversity, Evolutionary* ❐ Environmental Science* ❐ General* ❐ Chemistry+ ❐ Biological Chemistry* ❐ Environmental Science* ■ Computer Science+ ❐ Alternative* ❐ Honors* ❐ Earth Sciences ❐ Interdisciplinary Science: Environmental Interpretation ❐ Interdisciplinary Science: Physical Science ❐ Physics ❐ Undeclared.(For applicants who know they want to major in the School of Arts & Sciences but are unsure of their particular field or major)

SCHOOL OF BUSINESS BS Degree Majors: ❐ Accounting ❐ Entrepreneurship ❐ Finance ❐ Human Resource Management ❐ International Business ❐ Management & Organization ❐ Management Information Systems ❐ Marketing ❐ Undeclared (For applicants who

know they want to major in the School of Business but are unsure of their particular major)

Academic Programs:

See catalog for detailed information on academic programs

Please check one major and a specialization (*) where applicable SCHOOL OF EDUCATION & ❐ Secondary Education ❐ Biology PROFESSIONAL STUDIES

SCHOOL OF TECHNOLOGY

BS-ED Degree Majors: ❐ Early Childhood Education ❐ English/Human Growth & Development ❐ General Science/Human Growth & Development ❐ Mathematics/Human Growth & Development ❐ Elementary Education ❐ English ❐ English/Geography ❐ Geography ❐ History ❐ History/English (Linguistics) ❐ History/English (Writing) ❐ Mathematics ❐ Mathematics/Biology ❐ Mathematics/Earth Science ❐ Science: Biology ❐ Science: Earth Science

BS Degrees Majors & Specializations ❐ Civil Engineering Technology+ ❐ Composites & Polymer Materials Engineering Technology+ ❐ Construction Management+ ❐ Electronics Technology+ ❐ Industrial Technology+ ❐ Graphics Technology* ❐ Electro-Mechanical Technology* ❐ Environmental & Occupational Safety* ❐ Manufacturing* ❐ Networking Technology* ❐ Quality Management* ❐ Technology Management* (2+2) ❐ Manufacturing Engineering Technology+ ❐ Mechanical Engineering Technology+ ❐ Technology Education+ ❐ Undeclared (For applicants who

❐ Chemistry ❐ Earth Science ❐ English ❐ French ❐ German ❐ History ■ Integrated Science+ ❐ Biology* ❐ Chemistry* ❐ Earth Science* ❐ Physics* ❐ Italian ❐ Mathematics ❐ Physics ❐ Social Sciences ❐ Spanish

All Level Subjects ❐ Art ❐ Music ❐ Physical Education BS Degree (Non-Teaching) Majors ❐ Athletic Training+ ❐ Exercise Science & Health Promotion+ ❐ Physical Education+

know they want to major in the School of Technology but are unsure of their particular major)

Special Programs ❐ Nursing-BSN (Only for applicants who are licensed as CT-registered nurses)

❐ Undeclared (For applicants who

+ Major * Specialization

know they want to major in the School of Education & Professional Studies but are unsure of their particular field or major) 5

Extracurricular and Personal Activities Varsity Athletics (sports activity) _______________________________________________________________________________________ Musical Organizations

❑ Band ________________ ❑ Orchestra ________________ ❑ Vocal Group _________________ (instrument) (instrument) (group & range)

School Organizations (names and offices held) ___________________________________________________________________________ __________________________________________________________________________________________________________________ Other Organizations _________________________________________________________________________________________________ Special Interests ____________ _______________________________________________________________________________________ What activities do you hope to continue at CCSU? _________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________

Work Experience Please list any job (including summer employment) you have held during the past three years: Specific nature of work

Employer

Dates of employment

Number of hours per week

__________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________

Additional Information Have you visited CCSU?

❑ Yes

❑ No

If yes, when ___________ /_____ Month Year

Why are you interested in attending CCSU? __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ Please list other colleges where you have made applications: __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________

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Family Information ❑ FATHER

❑ GUARDIAN

______________________________________________________________________________________ Last First Middle Occupation______________________________________________ Firm/company_________________________________________________ Colleges attended, if any ___________________________________________________________ Degrees earned ______________________ ❑ MOTHER

❑ GUARDIAN __________________________________________________________________________________________ Last First Middle Occupation__________________________________________Firm/company______________________________________ Colleges attended, if any ___________________________________________________________ Degrees earned ______________________ Please list names and ages of your brothers and sisters. Also list the schools/colleges they are attending or have attended, the diplomas/degrees they have earned, and the dates they attended these institutions.

Name Age School/College Diploma/Degree Dates ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________

How Did You First Hear About CCSU? ❑ High School Counselor ❑ Teacher ❑ Parent/Guardian/Family Member ❑ Friend ❑ CCSU Alumni ❑ Current CCSU student ❑ College Fair ❑ High School Visit ❑ CCSU Admissions Representative ❑ Internet Search ❑ TV/Radio ❑ Newspaper ❑ Publication (Check one) ❑ School Guide ❑ Peterson’s ❑ Barron’s ❑ The Princeton Review ❑ Talbot’s ❑ CCSU Publication ❑ The Student Source ❑ College Outlook Magazine ❑ Newsweek ❑ Time ❑ U.S. News & World Report ❑ Other _______________________________________________

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Personal Statement - Required for First Year, Optional for Transfers Please choose one of the topics below and write a brief, one-page response to the question or statement. Please address this topic below or on a separate piece of paper: 1. Briefly describe any scholastic distinctions you have achieved. Which one of these achievements are you most proud of?

2. Write a brief autobiographical sketch of your high school years, highlighting work experience, volunteer work, extracurricular activities, participation in athletics and special recognition you have received.

3. Write a brief autobiographical essay on your work/professional career achievements, highlighting personal successes and examples of management or leadership. Emphasize what personal characteristics or skills you possess which make you well prepared for the academic rigors of college.

4. Where do you see yourself 10 years after graduation?

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Instructions for Transcript Request For your convenience, we have provided you with request forms that you may complete to authorize release of your official transcript. We are recommending that you contact the institution(s) to determine if a fee is charged for an official transcript. Please feel free to make additional copies of the transcript request forms.

High School/College Transcript Request

High School/College Transcript Request

(Check appropriate box or boxes) ❑ High School Transcript ❑ College/University Transcript

(Check appropriate box or boxes) ❑ High School Transcript ❑ College/University Transcript

Last Name

Last Name

SS#

First

MI

Maiden

Date of Birth

First

SS#

MI

Maiden

Date of Birth

Street __________________________________________________

Street __________________________________________________

City

City

State

List date(s) of attendance _______ /_______ Month Year

Zip _______ /_______ Month Year

State

List date(s) of attendance _______ /_______ Month Year

Zip _______ /_______ Month Year

Date did or will graduate _______ /_______ Month Year

Date did or will graduate _______ /_______ Month Year

I am requesting that an official transcript be forwarded to:

I am requesting that an official transcript be forwarded to:

The Office of Recruitment and Admissions Central Connecticut State University 1615 Stanley Street New Britain, CT 06050-4010

The Office of Recruitment and Admissions Central Connecticut State University 1615 Stanley Street New Britain, CT 06050-4010

Mail Transcript: ❑ immediately ❑ upon completion of current semester/marking period

Mail Transcript: ❑ immediately ❑ upon completion of current semester/marking period

Signature

Signature

Date

Date

Please include the $40 non-refundable application fee with this application payment form.

Semester of Application: ________________________________ Student’s Full Name:_________________________________________________________________________________________ Student’s Soc. Sec. Number: ____________________________ Daytime Phone # ______________________________________ Check # _____________or Money Order # _________________ Credit Card # _______________________________________________Exp. Date: _____________________ (Visa, Mastercard, or Discover) Name as appears on Credit Card: ______________________________________________________________________________ Signature of Credit Card Holder: _______________________________________________________________________________ 9