Fillable Printable University of Washington Application Form - University of Washington
Fillable Printable University of Washington Application Form - University of Washington
University of Washington Application Form - University of Washington
Q-1. Quarter. For which quarter and year are you applying? Check one box only
SUMMER 2015 (begins June 2015)AUTUMN 2015 (begins September 2015)WINTER 2016 (begins January 2016 )
Deadline: Dec. 1, 2014 Deadline: Dec. 1, 2014 Deadline: Sept. 1, 2015
PI-1. Sex/Gender. Male Female
PI-2. Social Security NumberPI-3. Date of Birth (mm) (dd) (yyyy)
PI-4. Legal Name: To avoid confusion, use your full legal name whenever you contact Admissions.
Last (Family) Name First (Given) Name Middle Jr., etc.
PI-5. Other Name(s): If your name has changed, indicate your former full name(s).
Last (Family) Name First (Given) Name Middle Jr., etc.
Last (Family) Name First (Given) Name
Middle Jr., etc.
Wherever you see this icon, find instructions in Part D of the accompanying instructions for freshman applicants.
You are accountable for providing complete and accurate information.
Omissions or inaccurate information may result in the denial of admission.
application for freshman admission & scholarships
also available online at admit.uw.edu/Admission/Freshmen/Apply
Personal Information (PI)
C-1. Type:First-time Freshman
C-2. Have you ever been or do you expect to be a Running Start participant (Washington State only)? Yes No
C-3. Have you ever been or do you expect to be a participant in College in the High School or other college enrollment program? Yes No
Classification(C)
Quarter
(Q)
Major or Area of Interest (MJ)
Previous Attendance (PA)
MJ-1. Major. What is your intended major or area of interest? (If undecided, choose one of the pre-majors options.)
Major code
MJ-2. Optional. Another Area of Interest.If you have another area of interest, please indicate it here.
Major code
PA-1. Have you ever applied for admission to the UW? No Yes: _______________________________ Quarter/Year
PA-2a. Have you ever attended the UW? No Yes
PA-2b.If yes, indicate the campus / type(s) of enrollment (check all that apply):
BothellDayDistance/Online LearningELP (ESL)EveningExtensionSummerTacomaUW College in the High School
PA-2c.Date of First Attendance (mm) (yyyy)PA-2d.UW Student Number (7 digits)______________________________
2015-16
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OFFICE USE ONLY
AD-1. Mailing Address
Number and Street
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.)
AD-2. Permanent Address Same as Mailing Address in AD-1 Different: complete the address information below
Number and Street
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.)
AD-3a. Home telephone (U.S. phone numbers only)
AD-3b. Cell phone (U.S. phone numbers only)
AD-4. Email
This must be a valid address that you check regularly. If it changes, notify Admissions promptly.
Address (AD)
CR-1. Birthplace City and StateCountry if other than U.S.
CR-2. Are you a U.S. citizen? Yes: skip the next three questions. No: go on to the next question.
CR-3. What is your country of citizenship? Specify country
CR-4. What is your country of permanent residence? Specify country
CR-5. Current or Expected Visa Type or Immigration Status
U.S. Permanent Resident/Immigrant Visa: Registration Number: A#
Date issued/to be issued (mm) (yyyy)
Refugee Political Asylee
International Student: visa types F, J or B, H, L, M, R, TD, TN
This is the wrong application. You need to complete the international application, available online at admit.uw.edu/Admission/International/Apply,
or contact the Office of Admissions at admit.uw.edu/Contact.
Other Visa Types (A, E, G, I, K, V) Visa Type and Number e.g., A-2, E-2, E-3, V-3
Date visa became (or will become) effective (mm) (yyyy)
Other: any status not included above ________________________________________________________________________________
CR-6. Are you a resident of Washington State? No
Yes: If yes, you must include dates of your most recent continuous residence in Washington State.
From (mm) (yyyy) to Present or to (mm) (yyyy)
Citizenship & Residency (CR)
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Family Information (F)
Family Information.Residents of Washington State under the age of 25 must provide information about at least one parent or legal guardian, preferably both. This
information is required to determine residency classification. Omission of parent/guardian information will result in classification as a nonresident.
All applicants are urged to respond to as many questions in this section as possible. Family information provides context for better understanding an applicant’s
educational environment and circumstances. The information you provide in this section will not disadvantage you in the admission process in any way.
Parent / Legal Guardian
F-1a. Mr.
1
Ms.
2
Mrs.
3
Dr.
4
Rev.
5
Other:
6
specify
F-1b. Name
Last (Family) Name First (Given) Name Middle Jr., etc.
F-1c. Primary parent/guardian for contact with the UWF-2. Relationship to you? Mother
1
Father
2
Guardian
3
Other:
4
specify
F-3. Is s/he living? Yes No: skip to F-8. F-4. Telephone F-5. Email
F-6. Address
Same as Mailing Address provided in AD-1 Same as Permanent Address provided in AD-2 Different:
Number and Street Apt.
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.)
F-7. Washington State resident? No Yes: From (mm) (yyyy) to Present or to (mm) (yyyy)
You must include the dates of parent/guardian’s most recent continuous residence in Washington State.
F-8. What is parent/guardian’s highest level of formal education completed? (check one)
Did Not Graduate High School
1
HS Graduate
2
Some College but No Degree
3
2-Year Coll. Degree
4
4-Year Coll. Degree
5
Postgraduate Study
6
F-9. If s/he attended college, list college(s) and degree(s):
COLLEGE U.S. STATE COUNTRYYEAR FROM YEAR TO
DEGREE
(yyyy) (yyyy)
F-10. Did s/he attend the University of Washington? Yes NoF-11. Occupation
F-12. Do you authorize the release of information in your admission file to the parent/guardian named in F-1b? Yes No
Parent / Legal Guardian
F-13a. Mr.
1
Ms.
2
Mrs.
3
Dr.
4
Rev.
5
Other:
6
specify
F-13b. Name
Last (Family) Name First (Given) Name Middle Jr., etc.
F-13c. Primary parent/guardian for contact with the UWF-14. Relationship to you? Mother
1
Father
2
Guardian
3
Other:
4
specify
F-15. Is s/he living? Yes No: skip to F-20 F-16. Telephone F-17. Email
F-18. Address
Same as Mailing Address provided in AD-1 Same as Permanent Address provided in AD-2 Different:
Number and Street Apt.
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.)
F-19. Washington State resident? No Yes: From (mm) (yyyy) to Present or to (mm) (yyyy)
You must include the dates of parent/guardian’s most recent continuous residence in Washington State.
F-20. What is parent/guardian’s highest level of formal education completed? (check one)
Did Not Graduate High School
1
HS Graduate
2
Some College but No Degree
3
2-Year Coll. Degree
4
4-Year Coll. Degree
5
Postgraduate Study
6
F-21. If s/he attended college, list college(s) and degree(s):
COLLEGE U.S. STATE COUNTRYYEAR FROM YEAR TO
DEGREE
(yyyy) (yyyy)
F-22. Did s/he attend the University of Washington? Yes NoF-23. Occupation
F-24. Do you authorize the release of information in your admission file to the parent/guardian named in F-13b? Yes No
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Family Information(F) CONTINUED
F-25. Income and Household Size.
Were you a Dependent or Independent Student for the 2013 tax year (or most recent year completed)? (Optional)
Dependent Student
Include income earned by your custodial parents/legal guardians, and include the number of dependents they claimed for tax purposes.
Independent Student
Include your income and, if married, your spouse’s income. Do not include as income any student financial aid you received in the form of
grants, loans or scholarships.
F-25a. Dependent Students Only
YEAR
PARENTS’ GROSS ANNUAL INCOME PARENT FAMILY SIZE
Most recent year completed _____________ $ ____________________.00 __________
Previous year _____________ $ ____________________.00 __________
F-25b. Independent Students Only
YEAR
STUDENTS’ GROSS ANNUAL INCOME STUDENT FAMILY SIZE
Most recent year completed _____________ $ ____________________.00 __________
Previous year _____________ $ ____________________.00 __________
SP-1. Will you be enrolling under the UW Faculty / Staff Tuition Exemption Program or Washington State Employees’ Tuition Exemption Program? Yes No
SP-2. Are you a veteran of U.S. Military Service, on active military duty, or a member of the National Guard; OR are you the spouse or child of a U.S. military veteran or
active duty service member? Yes No
If yes, select the option that will best describe your status upon enrolling at the UW:
I am a discharged veteran no longer serving on active duty or in the Reserve or National Guard.
I am on active duty.
I am a member of the National Guard.
I am a Reservist, not including ROTC.
I am the child or spouse of a U.S. military veteran or active duty service member.
SP-3. Have you been in foster care in Washington State for at least one year since your 16th birthday? Yes No
Special Programs (SP)
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Schools & Colleges Attended (SC)
Schools Attended Outside the U.S.
SC-1. Have you ever attended school outside the U.S.? No: skip the rest of SC-1. Yes: complete the other questions in SC-1.
Mark an X next to EACH grade you have attended outside the U.S.
__ 1 __ 2 __ 3 __ 4 __ 5 __ 6 __ 7 __ 8 __ 9 __ 10 __ 11 __ 12 __ 13 __ 14 __ 15 __ 16
List all schools you attended outside the U.S. beginning with Grade 1.
NAME OF SCHOOL LOCATION GRADE LEVEL(S) CALENDAR YEAR LANGUAGE OF
E.G. 2008-09 INSTRUCTION
example:
West Island School Hong Kong 9-12 2011-15 Mandarin
SC-3. High School Graduation
Have you graduated — or will you graduate — from high school (not GED)? Yes: mm/yyyy of Graduation No: Highest grade level completed
SC-4. Homeschool
Have you ever participated in a homeschool program? No Yes: select all that apply: Grade(s) 9 10 11 12
SC-5. High School / Secondary Schools Attended
List all high schools and secondary schools you have ever attended, are currently attending, or will attend before enrolling at the UW. Do not exclude or omit any,
regardless of how many credits you earn(ed) there or the nature of the program in which you were/are enrolled. Failure to disclose all schools may result in denial of
admission to the UW.
Last High School Attended
Other HIgh School(s) Attended (in reverse order of attendance)
SC-6.Colleges/Universities Attended
List all colleges and universities you have ever attended, are currently attending, or will attend before enrolling at the UW. Include colleges attended while also enrolled
in high school programs such as Running Start, College in the High School, etc. Do not exclude or omit any institutions, regardless of how many credits you earn(ed)
there or the nature of the program in which you were/are enrolled. Failure to disclose all colleges and universities may result in denial of admission to the UW.
Attach an additional page if necessary.YY
Last College Attended
Other College(s) Attended (in reverse order of attendance)
CEEB CODENAME OF COLLEGE, UNIVERSITY, ETC.LOCATION (CITY, STATE; COUNTRY IF OTHER THAN U.S.)
DATES OF ATTENDANCE (MM/YYYY)
FROM TO
CEEB CODE
NAME OF HIGH SCHOOL OR
SECONDARY SCHOOL
LOCATION (CITY, STATE; COUNTRY IF OTHER THAN U.S.)
DATES OF ATTENDANCE (MM/YYYY)
FROM TO
IF GRADE 9-12,
SPECIFY GRADE LEVEL(S)
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College Courses (CC-F)
This section will ask you about the college courses (exclude AP and IB) you have completed or are currently taking. List the details of each course in the appropriate section.
CC-F1. College Courses Completed
List all college courses completed to date. Even if you also list them in HSC-1, HSC-2, High School Coursework, please
list them again here.
COLLEGETERM TYPETERM/YEAR
PREFIX &
NUMBER
SHORT TITLE (20 Character limit)CREDITS
GRADE IN
COURSE
ex: Bellevue College
QTR SEM
Aut 2014Art 101Art Intro5B
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
CC-F3. College Courses In ProgressIt is very important that you list all college courses you are taking or planning to take before enrolling at the UW.
If your schedule is not final yet, please do not hesitate to complete this section. Just give us your best estimate about the courses you anticipate taking, with
specific titles. You can update your schedule later by email or postal mail.
COLLEGETERM TYPETERM/YEAR
PREFIX &
NUMBER
SHORT TITLE (20-character limit)CREDITS
GRADE IN
COURSE
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
QTR SEM
CC-F2. College Grade-Point Average (GPA)
Enter your college grade point average at right. This figure should be the cumulative GPA for all coursework,
as recorded on your college transcript. If you attended more than one college, list the GPA from the college
where you earned the most credit.
AL-1. Do you expect to earn an International Baccalaureate (IB) diploma? No Yes
AL-2. Have you already earned — or do you expect to earn — any advance-level credit (e.g., A-level, STMP, HKALE, Arbitur, etc.,) before enrolling at the University of
Washington? Do not include AP or IB credit.
No Yes: Please specify Certificate, Diploma, or Advanced Credit and date.
NAME OF SCHOOL CERTIFICATE/DIPLOMA/ADVANCED CREDIT DATE AWARDED OR EXPECTED (mm/yyyy)
ex:
Singapore American School A-Level 05/2014
Advanced Level Credit (AL)
DG-1. Have you already earned — or do you expect to earn — an associate or bachelor’s degree before entering the University of Washington?
No Yes: specify degree and date expected.
COLLEGE NAME OF DEGREE DATE OF DEGREE EARNED OR EXPECTED
ex:
Shoreline CC Associate in Science
-
Transfer June 2015
Degrees Earned or Expected (DG)
College GPA
(x.xx)
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High School Coursework (HSC) — PART I
Name of Applicant
ADD'L TERMS2ND TERM1ST TERM
GRADE IN SCHOOL
ENGLISH
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
MATH
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
LAB SCIENCE
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
WORLD
LANGUAGES
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
7 + 8
YR BEGIN YR END
9
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
10
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
11
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
12
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
ADD'L TERMS2ND TERM1ST TERM
Gr 9-11 Gr 9-11 Gr 9-11 Gr 9-11
Gr 12 Gr 12 Gr 12 Gr 12
TOTAL
YEARS
Highest Math Level: Name of World Language: Highest Level:
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Name of Applicant
High School Coursework + HS GPA (HSC) — PART II
GRADE IN SCHOOL
SOCIALSTUDIES/
SOCIALSCIENCE
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
FINE, VISUAL, OR
PERFORMING ARTS
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
OTHER SUBJECTS
COURSE TITLE
COURSE NOTATION
HS CREDITS
GRADE IN COURSE
7 + 8
YR BEGIN YR END
9
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
10
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
11
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
12
YR BEGIN YR END
CHECK TERM TYPE
Semester
Trimester
Block
Other
Summer
ADD'L TERMS2ND TERM1ST TERM
Gr 9-11 Gr 9-11 Gr 9-11
Gr 12 Gr 12 Gr 12
TOTAL
YEARS
HSC-3.
UnweightedGrade-Point Average
(GPA)
In the boxes beneath, enter your
GPA for grades 9 through 11.
fThis figure should be a cu-
mulative, unweighted GPA as
recorded on your high school
transcript.
Unweighted = 4.0 scale, with no
grade given more than 4 points.
fCalifornia applicants: Use the
unweighted cumulative GPA, not
the UC or CSU GPA.
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Write your name exactly as it appears on SAT test reports:
Last (Family Name)
First (Given Name) Middle (if any)
Write your name exactly as it appears on ACT test reports:
Last (Family Name)
First (Given Name) Middle (if any)
Admission Tests (AT)
Admission Tests. You are required to have all official test scores sent directly from the testing agency. Official test scores are received electronically.
Scores coming from a source other than the testing agency, such as your high school, are not acceptable and will not be accepted. For the self-reported
information requested below, record the scores for each test date.
Deadline: Test scores must arrive no later than December 31, 2014.
Go to admit.uw.edu/Admission/Freshmen/TestScores for complete, detailed information about reporting and submitting test scores.
AT-1. Check the box(es) of the tests you've taken or plan to take, then answer the follow-up questions for each test.
SAT Reasoning Test
Have you already taken this test? Yes: Go to DATE TAKEN
No: Go to DATE TO BE TAKEN OR RE-TAKEN
ACT with Writing
Have you already taken this test? Yes: Go to DATE TAKEN
No: Go to DATE TO BE TAKEN OR RETAKEN
SAT Scores
DATE TAKEN (MM/YYYY)
Verbal or Critical ReadingMathWriting
ACT Scores
DATE TAKEN (MM/YYYY)
CompositeEnglishMathematicsReadingScienceWriting
DATE TO BE TAKEN OR RE-TAKEN (mm) (yyyy)
DATE TO BE TAKEN OR RE-TAKEN (mm) (yyyy)
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CL-1. Checklist
I understand that a complete application, which includes the following materials, must be submitted by the application deadline:
f
Application
f
Writing Section
f
$60 nonrefundable application fee
f
Official test scores from ACT with Writing or SAT Reasoning Test, sent electronically from the testing agency
Transcripts: DO NOT SEND unless you receive a request from the Office of Admissions. The application asks you to tell us about your academic coursework.
Letters of Recommendation: DO NOT SEND.
Checklist (CL)
Signature (SS)
SS-1. In signing this form, I certify that the statements I have made in this application and include in subsequent correspondence are/will be
complete and true to the best of my knowledge. I acknowledge that it is my responsibility to be aware of all pertinent admission and
application requirements and that I have read and understand all application instructions. I understand that failure to disclose complete
and accurate information, or failure to submit all required application information and official documents — including those outlined in the
Checklist (CL-1) — may result in the denial of admission, withdrawal of admission, subsequent dismissal from the University of Washington,
or other corrective actions as necessary.
I understand that my complete application must be signed and submitted by the application deadline to be considered for admission.
Signature of Applicant ____________________________________________________________________ Date ___________________
2066208 / 09.18.2014
CH-1. Have you ever been convicted of or adjudicated to be guilty of a violent felony offense, required to register as a sex offender by any legal authority in the U.S. or any
other country, or are any charges involving a violent felony or sex offense pending against you at this time?
No Yes If you answered yes, go on to question CH-2.
CH-2. List all the offenses and/or pending charges, the date of each offense/charge, and the date of each conviction/adjudication. Also, describe the circumstances
surrounding each offense/charge and if you wish, you may provide a statement as to why you believe this information should not be a cause for concern about the
safety of the university community.
NOTE: The UW reserves the right to request additional information related to any of your criminal matters. Answers to these questions will be used primarily to decide
what support students may need to succeed at the UW. Please let us know if there are any special arrangements or restrictions we need to know about in order to
accommodate your attendance.
By signing this application (Question SS-1), you agree to immediately notify the Office of Admissions should there be a change of circumstances
that affects the accuracy of your answer to CH-1 between the date you submit your application and your first day of classes.
Criminal History (CH)
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Statistical Information (ST)
APPLICANT'S NAME DATE OF BIRTH mm dd yyyy
The University of Washington is required by the U.S. Department of Education to ask you about your ethnic identity.
The information you provide also allows the University of Washington to do the following:
1) We can report aggregate demographic data to state and federal agencies as required by law.
2) We can monitor the effectiveness of our recruitment and outreach efforts.
3) The information may assist in the awarding of privately funded diversity scholarships.
This information will be separated from your application file and will not be used in the admission review process.
ST-1. Are you of Hispanic or Latino origin?
No, I am not Hispanic in origin.
Yes, I am Hispanic in origin. Check all that apply.
Argentinian
700
Bolivian
701
Chilean
706
Colombian
707
Costa Rican
708
Cuban
709
Dominican
710
Ecuadorian
711
Guatemalan
716
Honduran
718
Mexican, Mexican American, Chicano
722
Nicaraguan
723
Panamanian
724
Peruvian
726
Puerto Rican
727
Salvadoran
712
Spanish
730
Uruguayan
734
Venezuelan
735
Other Hispanic Origin
(Specify):
739
American Indian or Alaska Native.
If possible, please specify tribal or corporate affiliation e.g., Chinook)
NOTE: Verification of tribal or corporate affiliation is recommended. UW departments and programs are encouraged to consider tribal or
corporate enrollment or affiliation as a positive factor in admission, financial aid, and outreach programs. Verification of affiliation —
which is required in order to benefit — consists of the following:
fOfficial tribal identification. Example: copy of a Tribal Enrollment card, treaty fishing card, corporation papers, or Bureau of Indian Affairs BIA) document.
fCertificate of membership verification by the BIA, a tribal enrollment official, community official or proof of direct descendance.
Asian. Check all that apply.
Asian American
621
Asian Indian
600
Bangladeshi
601
Bhutanese
602
Burmese
603
Cambodian
604
Cham
646
Chinese
605
Filipino
608
Hmong
609
Indonesian
610
Japanese
611
Korean
612
Laotian
613
Madagascar
639
Malayan
614
Maldivian
634
Mien
647
Mongolian
624
Nepali
635
Pakistani
616
Singaporean
637
Sri Lankan
617
Taiwanese
606
Thai
618
Vietnamese
619
Other Asian Origin (Specify:)
986
ST-2. How do you describe your race? Check all that apply.
Regardless of your answer to the previous question, please mark the following box(es) to indicate what you consider yourself to be.
African American or Black. Check all that apply.
African American
870
Eritrean
920
Ethiopian
921
Ghanaian
922
Kenyan
923
Nigerian
912
Somali
924
Other African Origin (Specify:)
871
Nigerian
912
Other African Origin (Specify:)
871
Caucasian or White.
800
Includes people of European, Middle Eastern, or North African descent.
Native Hawaiian or Other Native Pacific Islander. Check all that apply.
Fijian
676
Guamanian
660
Kosraean
667
Mariana Islander
661
Marshall Islander
662
Micronesian
669
Native Hawaiian
653
Pacific Islander
681
Palauan
663
Papua New Guinean
678
Ponapean
670
Samoan
655
Solomon Islander
679
Tahitian
656
Tarawa Islander
672
Tokelauan
659
Tongan
657
Trukese Chuukese
674
Vanuatuan New Hebrides Islander
680
Yapese
675
Other Pacific Island Origin Specify:
695
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