returning student admission form

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Registrar’s Office

1100 North Avenue • Grand Junction, CO 81501-3122

970.248.1555 (o) • 970.248.1131 (f) • 1.800.982.6372

[email protected]

RETURNING STUDENT ADMISSION FORM

PERSONAL INFORMATION

PLEASE PRINT LEGIBLY IN BLACK INK

Term and Year of Expected Enrollment: Fall Spring Summer of the year Last Term Attended:

Student CMU ID Number OR Social Security Number

(Disclosure of SS# is voluntary. The SSN is protected under FERPA privacy standards.

Colorado Mesa University uses the SSN to verify eligibility for the College Opportunity Fund, Financial Aid, and for other specific reporting needs.)

Full Legal Name (Last) (First)

Birth Date (mm/dd/yyyy)

Home Address (Street or P.O. Box)

Present Age

(Apt. #) (City/Town)

Male

E-mail Address (required)

(Middle)

Female

Cell Phone (with area code)

(County) (State)

Former Name, if applicable

Can we text you information?

YES NO

(Zip Code) Phone (with area code)

Mailing Address (Street or P.O. Box)

(Address to which admission information should be sent.)

Nation of Citizenship

(Apt. #) (City/Town) (County)

If not a U.S. citizen, please provide a copy of your permanent resident card.

(State) (Zip Code) Phone (with area code)

The following information is not used in any discriminatory manner. Please check as many as apply.

1

Ethnic Origin: Are you Hispanic or Latino?

YES NO

2

Race:

1. American Indian or Alaskan Native

Tribal Affiliation

Census number

2. Asian

What is your educational goal at Colorado Mesa University?

Note: Technical certificates and associate degree programs are offered through Western Colorado Community College, a division of Colorado Mesa University.

Non-degree Seeking Bachelor’s degree Associate degree (AA or AS) for transfer Associate degree (AAS) in technical program Technical certificate

Note: Students seeking a graduate degree, Masters or Doctorate, must see the academic department for admission in the program.

What is your intended major or proposed field of study?

Have you attended another college since you last attended Colorado Mesa University?

If yes, please list college(s) and dates attended:

Yes No

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

(If yes, you must request official transcripts from each institution be sent directly to Colorado Mesa University Registrar’s Office.)

TUITION CLASSIFICATION

Are you claiming in-state tuition classification as a Colorado resident?

YES NO If no, specify state of residence:

If yes, completion of the following questions is required. For students

under the age of 23

, please complete the section entitled “Parent/Legal Guardian.” Students who are

age 23 or older

need only complete the section entitled “Student.” Failure to complete the following information may result in your being classified as a non-resident and paying out-of-state tuition. If a question does not apply, do not leave it blank; mark “X” in the “N/A” column.

PARENT/LEGAL GUARDIAN*

(if student is under 23)

or

STUDENT

(if student is 23 or older)

N/A N/A

Dates of continuous physical presence in Colorado (MM/YY):

Dates of extended absences (more than 1 month) from CO (MM/YY):

From

From /

/ to to /

/ From

From

/

/ to to

/

/

Reason for absence:

Dates of employment in Colorado (MM/YY):

List the last three tax years CO income taxes have been filed (or less, if appropriate):

Have you or your parent(s) (if you are under 23) filed CO income taxes as a partial year resident during the past three years? (Please check box)

Current driver’s license number:

Date issued (MM/YY), State issued

If no driver’s license, current state I.D. card number:

Date issued (MM/YY), State issued

Vehicle license plate number:

List the last 3 years of CO motor vehicle registration:

Date of CO voter registration (MM/YY):

Date of purchase, lease or rental of any CO residential property (MM/YY):

If you are under 23 and your parents are separated or divorced, which parent(s) live in CO:

Dates of military service, if applicable (MM/YY):

From

YES

/

/

/

/

(attach an explanation)

,

,

/ to

,

,

/

NO

From

YES

/

/

/

/

(attach an explanation)

,

,

/ to

,

,

From / to / From / to

Dependents of non-resident, active duty military personnel stationed in Colorado may request a tuition adjustment to in-state status for tuition purposes. Call 970.248.1458 for more information.

Date of marriage (MM/YY) of student if student will be under 23 by date of enrollment (applicable only to determine residency status).

/

* Please submit a copy of court order appointing “legal guardianship” (not necessary for “parent”).

/

/

NO

IMPORTANT:

You must answer the following two questions:

1. Do you have a pending criminal charge or have your ever been convicted of a crime, made a plea of guilty, accepted a deferred judgment, been adjudicated or been required to register as a sex offender? (Misdemeanor traffic offenses are exempt.) IF YES, ATTACH A DETAILED EXPLANATION.

2. Have you ever been placed on probation, suspended, or expelled from any high school or postsecondary institution for other than academic reasons? IF YES, ATTACH A

DETAILED EXPLANATION

YES

YES

NO

NO

I, hereby, certify to the best of my knowledge, the information furnished in this application is true and complete. I understand that if found to be otherwise, it is sufficient cause for rejection, delay of admission or loss of credit. I herby consent to the release of my transcript(s) to the institution receiving this application.

Signature of APPLICANT

*** Electronic signatures are not accepted. This form must be printed and signed or emailed from your Colorado Mesa University email account. ***

Date

Revised: 07/31/15

PROGRAMS OF STUDY

Black indicates a concentration or emphasis within a major.

Accounting

(BS, Minor)

General Accounting

Public Accounting

Addiction Studies

(Minor)

Animation, Film and Motion

Design

(BFA)

Applied Mechanical

Engineering

(BS, AAS)

Archaeology

(Minor)

Art

(BFA, Minor)

Art History

Studio Art

K-12 Education Licensure

Athletic Training

(BS)

Biological Sciences

(BS, Minor)

Biology

Cellular, Molecular and

Developmental Biology

Ecology, Evolution and

Organismal Biology

Secondary Education Licensure

Business Administration

Technical Certificate

Decision Support

Supervision

Professional Certificate

Energy Management/Landman

Entrepreneurship

Insurance

BAS

Business

BBA, Minor

Business Economics

Emerging Markets

Energy Management/

Landman

Entrepreneurship

Finance

Hospitality Management

Human Resource Management

Information Systems

Insurance

Management

Managerial Informatics

Marketing

Master of Business Administration

Chemistry

(BS, Minor)

Biochemistry

Chemistry

Classical Studies

(Minor)

Computer Information

Systems

(BAS, BS, Minor)

Computer Science

(BS, Minor)

Construction Management

(BS)

Criminal Justice

(BA, BAS, Minor)

Criminal Justice

POST Academy

Dance

(BFA, Minor)

Decision Support

(Certificate)

Economics

(Minor)

See Business Administration

Education

See Teacher Education

Emergency Medical

Technician

Basic (Certificate)

Emergency Management and Disaster Planning

(Professional Certificate)

Energy Management/

Landman

(Professional Certificate)

English

(BA, Minor)

Literature

Writing

Secondary Education Licensure

Environmental Science

& Technology

(BS, Minor)

Entrepreneurship

(Professional Certificate)

Exercise Science

(BS)

Finance

See Business Administration

Forensics

(Minor)

Forensic Anthropology

(Minor)

Geographic Information

Science & Technology

(Professional Certificate, Minor)

Geology

(Minor)

Geosciences

(BS)

Environmental Geology

Geology

Secondary Education Licensure

Graphic Design

(BFA, Minor)

Visual Design

Health Informatics

(Professional Certificate)

History

(BA, Minor)

History

Secondary Education Licensure

Hospitality Management

(AAS, BAS, Minor)

Insurance

(Professional Certificate)

International Studies

(Minor)

Kinesiology

(BA)

Adapted Physical Education

Health and Fitness Promotion

K-12 Education Licensure

Liberal Arts

(AA)

Administrative Office Technology

Business Administration

Computer Information Systems

Early Childhood Education

Humanities

Social Science

Sport Management

Liberal Arts

(AS)

Biology

Computer Science

Geology

Mathematics

Physics

Sport Management

Liberal Arts

(BA)

Elementary Education Licensure

English

Mathematics

Social Science

Non-education Option

Managerial Informatics

(Minor)

Marketing

See Business Administration

Mass Communication

(BA, Minor)

Media Strategies and Applications

Mathematics

(BS, Minor)

Mathematics

Statistics

Secondary Education Licensure

Mechanical Engineering

(BSME)

CMU/CU-Boulder Mechanical

Engineering Partnership Program

Medical Laboratory

Technician

(AAS)

Music

(BA, Minor)

Elective Studies in Business

Liberal Arts

Performance

K-12 Education Licensure

Nursing

(PN, AAS/RN, BSN, MSN, DNP)

Personal Training

(Minor, Professional Certificate)

Philosophy

(Minor)

Physics

(BS, Minor)

Political Science

(BA, Minor)

Psychology

(BA, Minor)

Counseling Psychology

Psychology

Radiologic Technology

(BAS, AAS)

Social Work

(BSW, Minor)

Sociology

(BA, Minor)

Sociology

Spanish

(BA, Minor)

Applied Professional Spanish

Literature & Language

Secondary Education Licensure

Speech

(Minor)

Sport Management

(BS, Minor)

Statistics

(Minor)

Supervision

(Certificate)

Sustainability Practices

(Certificate)

Animation

See Visual Communications

Administrative Office

Technology

(AA, AAS, Certificate)

Agricultural Science

(AS)

Baking & Pastry

(AAS, Certificate)

Business Administration

(AA)

Decision Support (Certificate)

Supervision (Certificate)

Computer-Aided Design

Technology

(AAS, Certificate)

Construction Technology

(AAS, Certificate)

Supervision

Criminal Justice

(AAS)

Culinary Arts

(AAS, Certificate)

Early Childhood Education

(AA)

Teacher (Certificate)

Director (Certificate)

Electric Lineworker

(Certificate)

Emergency Medical

Technician

Basic (Certificate)

Liberal Arts

(AA)

Administrative Office Technology

Business Administration

Computer Information Systems

Early Childhood Education

Humanities

Social Science

Liberal Arts

(AS)

Biology

Computer Science

Geology

Mathematics

Physics

Sport Management

Machining

(AAS, Certificate)

Manufacturing Technology

(AAS, Certificate)

Computer-Aided Design

Technology

Machining

Welding

Teacher Education

Initial Licensure

Students must complete program of study in addition to required coursework through the Center for Teacher Education.

Elementary Education:

Liberal Arts (BA)

Secondary Education:

Biology (BS)

English (BA)

Geosciences (BS)

History (BA)

Mathematics (BS)

Spanish (BA)

K-12 Education Licensure:

Art (BFA)

Kinesiology (BA)

Music (BA)

Education

(MA, Graduate Certificate)

Educational Leadership/

Principal Licensure

English for Speakers of

Other Languages (ESOL)

Exceptional Learner/

Special Education

Teacher Leader

Post-Baccalaureate Licensure:

Elementary

Secondary

Theatre Arts

(BA, BFA or Minor)

Acting/Directing

Design/Technology

Music Theatre

Theatre (General)

Watershed Science

(Minor)

Women’s & Gender Studies

(Minor)

Note: Unless otherwise indicated, all certificates are technical.

Mechanical Engineering

Technology

(AAS)

Medical Office Assistant

(AAS, Certificate)

Nurse Aide

(Certificate)

Nursing

(PN, AAS/RN)

Police Officer Standards

& Training (POST)

(Certificate)

Process Systems Technology

(AAS)

Public Safety Diving

(Certificate)

Radiologic Technology

(AAS)

Real Estate Broker

(Certificate)

Sustainable Agriculture

(AAS)

Sustainability Practices

(Certificate)

Technology Integration

(AAS, Certificate)

Network/Telecommunication

Telecommunications/VoIP

Transportation

(AAS, Certificate)

Automotive

Diesel

Visual Communications

(AAS, Certificate)

Animation

Welding

(AAS, Certificate)

Water Quality Management

(AAS)

Wildland Fire Management

(AAS)

Note: Unless otherwise indicated, all certificates are technical.

coloradomesa.edu

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