Purdue University Application Form - Purdue University

Fillable Printable Purdue University Application Form - Purdue University

Purdue University Application Form - Purdue University

First-time Freshman - If you have

never attended a college, submit this

application and an official high-school

transcript or GED scores. If you gradu-

ated from high school less than three

year ago, submit SAT I or ACT scores.

Non-Degree - If you are planning to

take a few courses for credit, but do not

intend to pursue a degree, submit this

application. Non-degree students may

apply no more than 18 semester hours

of work towards an undergraduate

degree at a Purdue campus. Non-

degree students are not eligible for

financial aid.

Application for

Undergraduate Admission

1401 South U.S. Hwy. 421

Westville, IN 46391-9542

1-219-785-5505

1-800-872-1231(in-state)

AIM: pncadmissions4

email: [email protected]

www.pnc.edu/admissions

n equal access/equal opportunity university

Transfer - If you have attended college,

but never attended PNC or another

Purdue campus, submit this application,

an official high school transcript or GED

scores and official transcripts from

all colleges you have attended. If you

hold a bachelor's degree, you do not

need to submit a high school transcript.

There is a one time $30 transcript evalua-

tion fee on transcripts outside of the

Purdue system.

Re-entry - If you previously attended

PNC or another Purdue campus as a

regularly admitted student, submit this

application and official transcripts from

any colleges attended since your last

enrollment at Purdue.

Permanent Regional Campus

Transfer from Purdue - If you are

currently attending another Purdue

campus and want to transfer perma-

nently to PNC, submit this application.

Temporary Regional Campus

Transfer from Purdue - If you are

currently attending another Purdue

campus and want to take classes

temporarily at PNC, submit this

application.

Non-Degree With College Course

Work or "Guest" - If you are planning

to take a few courses for credit, but do

not intend to pursue a degree, submit

this application. You may enroll tem-

porarily at PNC for up to 18 credit hours.

Some Previous College Work

Why We Want To Know

Although reporting your Social Security Number (SSN) to Purdue North Central is not required and your SSN

will not be used as your Purdue student identification number, it is required to receive certain federal tax ben-

efits. Additionally, the SSN is helpful to accurately match your application with other records such as SAT or ACT

scores. Disclosure of your SSN will be restricted to university business processes, such as those required for fed-

eral and state reporting as well as institutional purposes. By providing your SSN, you authorize the university

to disclose it to third parties as necessary for these purposes.

Purdue University is committed to assisting all members of the campus community in providing for their own

safety and security. The University prepares an Annual Security Report containing statistics and information re-

lating to campus safety and security policies and programs. All admitted students will receive Purdue Univer-

sity North Central Annual Security Report Notice. The report is available at www.pnc.edu/pd/safety.html, If you

would like a paper copy of the Report, please call 219-785-5220.

nstructions for applying to Purdue North Central

• Type or print clearly your full, legal name in ink

• Students transferring from another university must submit a $30 transcript evaluation fee.

•

Missing or incorrect items will delay processing of your application

• If you have been academically dismissed from any Purdue campus contact PNC Enrollment Services

for readmissions instructions and deadlines.

• You may apply online at www.pnc.edu/admissions/undergrad.html

Purdue University North Central is an equal access/equal

opportunity university. No qualified person will be denied

admission or employment, nor will any student or employee be

subjected to discriminatory treatment or be excluded from

participation in any educational program or activity on the basis

of race, religion, color, sex, age, national origin, disability, or

status as a disabled Vietnam era veteran.

No Previous College Work

revised 8/12

Students with Disabilities – Purdue University North Central is

committed to providing equal access and equal opportunity to

University courses, activities and programs for students with

disabilities. Students with documented disabilities that sub-

stantially limit a major life activity, such as learning, walking or

seeing, may qualify for academic adjustments and/or services.

To request information about academic adjustments, auxiliary

aids, or services, please contact the Disability Services Coordina-

tor at (219) 785-5374. Relay Indiana is used for TDD Communi-

cations 800-743-3333.

A student can begin any of the programs below at Purdue North Central. After 1, 2 or 3 years, the student can apply for transfer to complete the degree at another

Purdue campus or another college or university. This is a partial listing of majors/programs. See www.purdue.edu for complete listings.

PURDUE NORTH CENTRAL DEGREES

* A graduate degree in Education offered by West Lafayette on the Purdue North Central Campus.

Aeronautical and Astronautical Engineering

Agribusiness Management

Agricultural and Biological Engineering

Animal Agribusiness

Animal Production

Apparel Design and Technology

Applied Mathematics

Art Education

Art History

Athletic Training

Aviation Technology

Biological and Food Process Engineering

Biomedical Engineering

Chemical Engineering

Chemistry

Dietetics

Entomology

Farm Management

Financial Counseling and Planning

Fine Arts

Fisheries and Aquatic Sciences

Food Science

Foods and Nutrition in Business

Forestry

Health and Safety Education

Health Promotion

Horticultural Science

Hospitality and Tourism Management

Interdisciplinary Science

International Agronomy

Landscape Architecture

Mathematics Education

Mathematics/Computer Science

Movement and Sport Science

Natural Resources

Nuclear Engineering

Nutrition, Fitness, and Health

Occupational Health Science

Personal Fitness Training

Physical Education

Radiologic Health Science

Selling and Sales Management

Turf Science

Wildlife

Wood Products Manufacturing Technology

MASTER’S DEGREES

(Requires Graduate Application)

Business Administration

Elementary Education *

BACHELOR’S DEGREES

ehavioral Science (LA)

Psychology

Sociology

Biology (S)

Concentrations in:

Ecology

Microbiology

Pre-Dentistry

Pre-Medicine

Pre-Veterinary Medicine

Business (B)

Concentrations in:

Accounting

Economics

Management

Marketing

Communication (LA)

Computer & Information Technology (ET)

Construction Engineering and

Management Technology (ET)

Early Childhood Education (LA)

lectrical Engineering (ET)

Elementary Education (LA)

Engineering Technology (ET)

Concentrations in:

Electrical & Computer Engineering

Technology

Industrial Engineering Technology

Interdisciplinary Engineering Technology

English (LA)

istory (LA)

Human Resources (B)

Liberal Studies (LA)

Concentrations include, but are not limited

to the following:

Behavioral Science

Business

Communications

Math Statistics

Natural Science

Organizational Leadership & Supervision

Mechanical Engineering (ET)

Mechanical Engineering Technology (ET)

Nursing (S)

Nursing - BS

Nursing 2+2 to BS Degree Completion

Organizational Leadership & Supervision (B)

Psychology (LA)

econdary Education (LA)

Subject tracks in:

Life Sciences

Math

Physical Science

Social Work (LA)

ASSOCIATE DEGREES

Building Construction Management (ET)

Computer & Information Technology (ET)

Electrical Engineering Technology (ET)

echanical Engineering Technology (ET)

Organizational Leadership & Supervision (B)

Emphasis in Human Resources

Organizational Leadership & Supervision (B)

CERTIFICATES

Computer & Information Technology (ET)

Human Resources (B)

Mechanical Engineering Technology (ET)

Office Productivity (ET)

Organizational Leadership & Supervision (B)

Process Improvement (ET)

Professional Communication (LA)

Quality Control (ET)

Supervision (online) (B)

TRANSFER PROGRAMS

Application for Undergraduate Admission

Missing or incorrect information will delay consideration of your application. Please print clearly.

_____________________________________________________________ ____________________________

ast Name First Middle Maiden (or other former name)

________/________/_________ __________________________________ ___________

irth Date (Mo/Day/Yr) Social Security Number Gender

___________________________________________________________________________________________

Street Address City State Zip

(_______) ___________________________________ ___________________________________________

Home Phone County (if an Indiana Resident)

(_______) ___________________________________ ____________________________________________

ell Phone Student’s Email

1. Ethnicity: Hispanic or Latino Non-Hispanic or Non-Latino

Race: American Indian/Alaskan Native Asian Black or African American

Native Hawaiian or other Pacific Islander White

(Check the appropriate boxes. State and federal laws pertaining to civil rights require the university to report ethnic data.)

2. Your place of employment _______________________________________________________________ Full-time Part-time

3. If out of school for more than 12 months, describe your activities since your last enrollment

(employment, homemaking, military service, etc.)

______________________________________________________________________________________________________________________________

4. Country of citizenship: United States Other (specify country) _____________________________________________________

5. If non-U.S. citizen: Permanent Resident Number __________________________

(Attach a copy of Green Card or I-94 form)

International Asylee or Refugee None of the Above By selecting “None of the Above” as my citizenship type, I understand

that I am not eligible for Indiana resident tuition.

6. Residence: Which state (or foreign country) do you claim as your legal residence? ____________________ _______________________

State Foreign Country

Dates you have lived in Indiana: Birth to present Indiana resident (m/y) ________ to (m/y) ________ Never resided in Indiana

7. Parent or Guardian (if under 21) ___________________________________________________________

Last First Middle

_____________________________________________________________________________ (______)______________________

Number/Street City State Zip Parent Phone

8. Have either of your parents earned a four-year college degree? yes no

For research purposes only

9. Are you a veteran? Yes, (attach photocopy of DD 214 ) No

10. Alumni Affiliation: Check any that have attended or are attending Purdue University. Father Mother Brother Sister

11. If admitted, when will you begin at PNC? Fall (August) Spring (January) Summer I (May) Summer II (June) Year 20___

12. Have you attended another Purdue Campus? Yes No If yes, specify last campus attended ___________________________

13. Intended major _______________________________________________________________________________________________

Admissions Office

(219) 785-5455 • (219) 462-4197 • (800) 872-1231 (in-state) • Relay Indiana (800) 743-3333

fficial Use Only

PU ID# ___________________

ate Rec’d ___________________

val Fee ___________________

heck ___________________

Proc Int ___________________

14. High school information _______________________________________________________________________________________

ame City State

Year of graduation ________________ GED completion date (if applicable) _______________________

Indicate all date(s) you took or will take the SAT and/or ACT ___________________ ____________________ ___________________

AT (month/year) ACT (month/year) Neither

15. Are you on academic probation with any university/college? yes no Have you been dropped from any university/college? yes no

16. List all colleges/universities you have attended. See cover page for transcripts required for your admission status. Place an asterisk (*)

next to any institution in which you are currently enrolled. Failure to provide official transcripts will disqualify your application.

Transcripts for another Purdue Campus do not need to be submitted.

_____________________________ _____________________ _____________ _____________ ____________________________

Name of college/university City and State From (Month/Year) to (Month/Year) Degree and year received (if applicable)

_____________________________ _____________________ _____________ _____________ ____________________________

Name of college/university City and State From (Month/Year) to (Month/Year) Degree and year received (if applicable)

____________________________ _____________________ _____________ _____________ ____________________________

Name of college/university City and State From (Month/Year) to (Month/Year) Degree and year received (if applicable)

17. My intention is to (check all that apply) Be a full-time student Complete my degree at PNC

Complete my degree at another Purdue campus Complete my degree outside the Purdue system

Be a part-time student Take 1 or more courses, but do not plan to earn a degree

18. If Non-Degree my intention is to

(check all that apply) Pursue a degree program at PNC Take one or two courses at PNC

Pursue a certificate at PNC Renew teaching license

19.

I certify that all the information provided is accurate and true. I understand that falsified information may result in denial of admission and/or termination of

enrollment at Purdue University North Central. I affirm, under the penalties for perjury, that the following representations, including information related to my

citizenship status and/or presence in the United States, are true. I authorize Purdue University North Central to report my admission status and academic program

to my high school counselor for the purpose of curriculum development and improvement of instruction. I authorize secondary and post-secondary schools I have

attended to release information needed by Purdue University North Central to process and verify my application. I authorize Purdue University North Central's

Division of Financial Aid to release, as it deems appropriate, information on my academic program (including grades) and the amount of any financial award I may

receive to agencies, institutions, and others involved in providing funds for my education. I agree to abide by the policies, rules and regulations of PNC.

_____________________________________________________ ___________

Signature of Applicant Date

A complete application will ensure the processing of your application as quickly as possible. All records submitted become the property of Purdue University.

For current high school students only (to be completed by the high school guidance counselor)

Please complete the information below and append any information that might help PNC make an informed admission decision. Attach an official copy of

the applicant’s H.S. transcript, including courses in progress and SAT or ACT scores and mail to: PNC Admissions, 1401 S. U.S. Hwy. 421, Westville, IN 46391

Student Name ______________________________ Accreditation: High School is accredited not accredited by a state educational agency

Rank in Class ______/______ after six seven eight semesters school does not rank students G.P.A. _______ Scale _______

Test scores

SAT: Date _________ CR _____________ M _____________ W _____________

ACT: Date _________ E _____________ M _____________ R _____________

SR _____________ C _____________ EW ____________

Indiana residents only Applicant: Pursuing CORE 40 Diploma yes no Passed GQE/ISTEP yes no Passed ECA yes no

Please do not leave blank Pursuing Academic Honors Diploma yes no Pursuing Technical Honors Diploma yes no

Twenty-first Century Scholar yes no

Senior year course in progress: (if school is on a block schedule, please list courses in all blocks for senior year)

Seventh Semester (Block 1/Block 2) Eighth Semester (Block 3/Block 4)

______________________________________________ ______________________________________________

Comments _____________________________________________________________________________________________________________________________

____________________________________________ ___________________________________________ ____________

Counselor’s Signature Counselor’s Name (Please Print) Date

____________________________________________ ____ ____ ____ ____ ____ ____ (____) _____________________

High School CEEB Code Number Guidance office phone number