Texas Southern University Application Form

Fillable Printable Texas Southern University Application Form

Texas Southern University Application Form

TEXAS SOUTHERN UNIVERSITY

OFFICE OF UNDERGRADUATE ADMISSIONS

3100 Cleburne Street ~ Houston, Texas 77004

713-313-7071

APPLICATION FOR E ARLY A DMISSION

A non-refundable application fee (check, money order or credit card) must accompany this application.

U.S. citizen/permanent resident - $42.00

Please

type or print clearly

1. Expected date of enrollment _____________________________ Fall Spring I Summer II Summer

Name ________________________________________________________________ Social Security No. _______________________________

List other name(s) previously used _________________________________________ E-mail address ________________________________ __

Present mailing address _________________________________________________________________________________________________

Length of time applicant resided at above address ____ Home pho ne __________________________ Wo rk phone _____________________ ____

6. Permanent home address ________________________________________________________________________________________________

7. Date of birth _______________________________________ Place of birth ________________________________________ Sex: M F

8. What will be your major at TSU? (Choose from the list) _______________________________________________________________________

Name of parent, legal guardian or relative who can be contacted in case of an emergency ___________________________________ ____________

Addres

s ______________________________________________________________________ Phone _________________________________

. Indicate your ethnic identity below by checking the appropriate box. This information is optional and will be used for stat istical purposes only.

African-American/Black African Asian or Pacific Islander Hispanic White

American Indian/Alaskan native Other ________________________________________

. What high school you are attending? ________________________________________________________________________________________

. Your expected high school graduation date: ____________________

. Do you presently have a diploma? Yes No

. SAT combined score: ________________ ACT composite score: _____________________

. Are you a U.S. citizen? Yes No State of legal residence _______________________________________________________________

. Do you hold permanent residence status for the U.S.? Yes No

17.

If yes, date permanent card issued (attach copy) __________________________ Card number ________________________________________

. Have you ever been convicted of a felony? Yes No If yes, please explain _________________________________________________

. Have you taken the Texas Assessment of Knowledge and Skills (TAKS) Test? Yes No

yes, bring personal copy of scores with you at registration.

. When did you request your ACT / SAT be forwarded to Texas Southern University? Date ________________________________________ ________

OATH OF RESIDENCY FOR THOSE CLAIMING TEXAS RESIDENCY ONLY

. Are you claiming Texas residency for tuition purposes? Yes No

yes, upon whom are you basing claim for residency? Self Parent Legal guardian (Proof of guardianship must be provided)

. If claim of residence is based on self, please answer the following questions:

(a)

How long have you resided In Texas? _____________ Years _____________ Months

(b)

Previous state or country of residence ___________________________________________________________________________________

If you came here within the past 5 years, why did you move to Texas? Education Employment Other ________________________

Computer Science

Physic

Enginee

ring Technology

Biomedical

Engineering Technology

Civil

Engineering Technology

Electronics

Engineering Technology

Environmental Engineering Technology

Indust

rial Technology

Const

ruction Technology

Design

Technology

Automated Manufacturing Technology

Mathematics

Airway

Science

Airw

ay Computer Science

Air

way Science Management

PHARM

ACY AND HEALTH SCIENCES

Entry

Level Doctor of Pharmacy

Environmental

Health

Administration

Health

Information Management

Respirato

ry Therapy

Medical Technology

COLLEGE

OF SCIENCE AND

TECHNO

LOGY

Bachelor

of Science

ology

mprehensive

Pre-Medical, Pre-Dental, and Pre-Veterinary

Pre-Optometr

Pre-

Physical Therapy

Chemistry

(ACS) American Chemical Society Approved

Pre-Medical

and Pre-Dental

LIBERAL ARTS AND

BEH

AVIORAL SCIENCES

chelor of Arts

Communications

Speech

Communication

Journalis

Telecommunications

glish

French

Spanis

Fine Arts

Art

Music

Theatre

story

Economic

General

Studies

Administ

ration

Cultural

Studies

Psychology

Sociolog

Social

Work

Political

Science

Bachelor

of Science

Public Affairs

Administration

of Justice

Dietetic

Human

Services and Consumer Sciences

Child

and Family Development

Food

and Nutrition

SCHOOL

OF BUSINESS

chelor of Business Administration

Accounting

Finance

Management

Marketing

COLLEGE OF EDUCATION

Bachelor

of Science

Interdisciplinary

Studies

Bilingual

Education

Early

Childhood Education

Englis

Mathematic

Rea

ding

Spanis

Special

Education

Healt

h I (Secondary Teaching)

Health

II (Non Teaching)

Human

Performance

Hum

an Performance I (All teaching levels)

man Performance II (Secondary Teaching)

UNDERGRADUATE M AJORS

No. and Street City State Zip Code

Cit

y State/Country

Name Cit

y State

No.

and Street City S tate Zip Code Country

Las

t First Middle

- -

( )( )

Month Day Year

Mont

h Year

( )

Last First Middle

23. If claim for residency is based upon parent or legal guardian, please answer the following questions:

(a) Name of person upon whom claim is based _______________________________________________________________________________

(b) Address of person upon whom claim is based _____________________________________________________________________________

(d) Previous state or country of residence ___________________________________________________________________________________

(e) If this person came here within the past 5 years, why did this person move to Texas? ❏ Education ❏ Employment Other _______________

(f) Is this person a U.S. citizen? ❏ Yes ❏ No

(g) Has parent or legal guardian claimed you as a dependent for U.S. income tax purposes for the tax year preceding your registration? ❏ Yes ❏ No

(h) Will this person claim you for the current tax year? ❏ Yes ❏ No

(i) Is your parent or legal guardian currently on active military duty assignment in Texas? ❏ Yes ❏ No

(j) Was your parent or legal guardian a resident of Texas when he or she joined the military? ❏ Yes ❏ No

FURTHER DOCUMENTATION OF RESIDENCY MAY BE REQUIRED.

OPTIONAL INFORMATION

Although the information requested below is optional, including this information may assist your admittance. You are strongly encouraged to complete this section.

24. Please indicate the highest level of your parents’ or legal guardian’s educational background:

Father/legal guardian ❏ No high school ❏ Some high school ❏ High school diploma or GED

❏ Some college ❏ Bachelor’s degree ❏ Graduate/Professional degree

Mother/legal guardian ❏ No high school ❏ Some high school ❏ High school diploma or GED

❏ Some college ❏ Bachelor’s degree ❏ Graduate/Professional degree

25. Please indicate, for the most recent tax year, your family’s gross income. Include both untaxed and taxed income.

❏ Less than $20,000 ❏ $20,000-$39,000 ❏ $40,000-$59,000 ❏ $60,000-$79,000 ❏ More than $80,000

I understand that information submitted herein will relied upon by university officials to determine my status for admission and residency eligibility. I

authorize the university to verify the information I have provided. I agree to notify the proper officials of the institution of any changes in the information

provided. I certify that the information on this application is complete and correct and understand that the submission of false information is grounds for

rejection of my application, withdrawal of any offer of acceptance and/or cancellation of enrollment from the university.

Signature __________________________________________________________ Date _________________________

Parents/Guardian signature _________________________________________ Date ________________________

Texas Southern University admits students without regard to their sex, disability, race, color, creed or national origin and entitles them to all the rights,

privileges, programs and activities generally accorded to its students. Texas Southern University does not discriminate on the basis of race, color, national

or ethnic origin or sex or against otherwise qualified disabled students in its admission, academic and other standards, nor for other financial aid, nor in the

planning and administration of any of its academic programs.

APPLICATION FEE PAYMENT INFORMATION

Your application fee is for the: Year _______________ ❏ Fall Semester ❏ Spring Semester ❏ Summer Session I ❏ Summer Session II

Name: ______________________________________________________________ Social Security Number: ________________________________

(Optional: This will ensure your documents are matched and processed promptly. )

Please check method of payment:

❏ Check or money order (Be sure to include your name and Social Security number on the check or money order enclosed with the application.)

Credit card: ❏ Visa ❏ Master Card ❏ Discover ❏ American Express

Account Number: _____________________________________________________ Expiration Date: _______________________________________

Name of Cardholder: ______________________________________________ Cardholder Signature: _______________________________________

OFFICE USE ONLY

Exemption Approved _______________________________________ Exemption Denied ________________________________________________

By ________________________________________________________________ Date ________________________________________________

No. and Street City State Zip

Last First Middle