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
2.
Name ________________________________________________________________ Social Security No. _______________________________
3.
List other name(s) previously used _________________________________________ E-mail address ________________________________ __
4.
Present mailing address _________________________________________________________________________________________________
5.
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) _______________________________________________________________________
9.
Name of parent, legal guardian or relative who can be contacted in case of an emergency ___________________________________ ____________
Addres
s ______________________________________________________________________ Phone _________________________________
10
. 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 ________________________________________
11
. What high school you are attending? ________________________________________________________________________________________
12
. Your expected high school graduation date: ____________________
13
. Do you presently have a diploma? Yes No
14
. SAT combined score: ________________ ACT composite score: _____________________
15
. Are you a U.S. citizen? Yes No State of legal residence _______________________________________________________________
16
. Do you hold permanent residence status for the U.S.? Yes No
17.
If yes, date permanent card issued (attach copy) __________________________ Card number ________________________________________
18
. Have you ever been convicted of a felony? Yes No If yes, please explain _________________________________________________
19
. Have you taken the Texas Assessment of Knowledge and Skills (TAKS) Test? Yes No
If
yes, bring personal copy of scores with you at registration.
20
. When did you request your ACT / SAT be forwarded to Texas Southern University? Date ________________________________________ ________
OATH OF RESIDENCY FOR THOSE CLAIMING TEXAS RESIDENCY ONLY
21
. Are you claiming Texas residency for tuition purposes? Yes No
If
yes, upon whom are you basing claim for residency? Self Parent Legal guardian (Proof of guardianship must be provided)
22
. 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
s
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
Health
Administration
Health
Information Management
Respirato
ry Therapy
Medical Technology
COLLEGE
OF SCIENCE AND
TECHNO
LOGY
Bachelor
of Science
Bi
ology
Co
mprehensive
Pre-Medical, Pre-Dental, and Pre-Veterinary
Pre-Optometr
y
Pre-
Physical Therapy
Chemistry
(ACS) American Chemical Society Approved
Pre-Medical
and Pre-Dental
LIBERAL ARTS AND
BEH
AVIORAL SCIENCES
Ba
chelor of Arts
Communications
Speech
Communication
Journalis
m
Telecommunications
En
glish
French
Spanis
h
Fine Arts
Art
Music
Theatre
Hi
story
Economic
s
General
Studies
Administ
ration
Cultural
Studies
Psychology
Sociolog
y
Social
Work
Political
Science
Bachelor
of Science
Public Affairs
Administration
of Justice
Dietetic
s
Human
Services and Consumer Sciences
Child
and Family Development
Food
and Nutrition
SCHOOL
OF BUSINESS
Ba
chelor of Business Administration
Accounting
Finance
Management
Marketing
COLLEGE OF EDUCATION
Bachelor
of Science
Interdisciplinary
Studies
Bilingual
Education
Early
Childhood Education
Englis
h
Mathematic
s
Rea
ding
Spanis
h
Special
Education
Healt
h
Healt
h I (Secondary Teaching)
Health
II (Non Teaching)
Human
Performance
Hum
an Performance I (All teaching levels)
Hu
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
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