Race:

Please check if you are:


For Non-Hispanics only:

Please check race as applicable (you may select more than one)





(Information regarding the applicant's race or ethnicity is voluntary, and will be used in a nondiscriminatory manner, consistent with applicable civil rights laws.)
 

Have you ever been dismissed from another college or university?


If so for what reason?



If Other, please explain below:

Please list all colleges/universities you have attended:

If this is your first time to enter college, please indicate if you have completed high school or have a GED:

GED:


High School Graduate: