APPLICATION FOR UNDERGRADUATE ADMISSION
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Application for Undergraduate Admission UNDERGRADUATE ADMISSIONS CHECKLIST Beginning Freshman Before mailing your application, check to see if all requirements are met. q Completed application with $25 non-refundable fee q Official high school transcript q Official SAT or ACT scores q Proof of Immunization Non-Traditional Freshman (out of school 5 yrs and never attended college) q Completed application with $25 non-refundable fee q Official high school transcript with graduation date and/or official copy of GED certificate and GED test scores q Proof of Immunization Personal Development Accel/Joint Enrollment q Complete the checklist for Beginning Freshmen above q Accel Application (on-line at www.gacollege411.org) Transfer q Completed application with $25 non-refundable fee q Official transcripts from each college attended (if currently enrolled, send preliminary transcripts now and final transcripts upon term completed) q Proof of Immunization q If less than 30 hours of college credit, meet requirements for Beginning Freshmen (see above) Transient q Completed application with $25 non-refundable fee q Official letter of transient permission from home institution q Proof of Immunization q Non-priority registration applies (no credit will be awarded) q Completed application with $25 non-refundable fee q Official proof of high school graduation or GED q Proof of Immunization International q q q q q q q Completed application with $25 non-refundable fee TOEFL or SAT scores Foreign Student Financial Statement Affidavit/letter of financial support by sponsor/parents Official transcripts (secondary and college) Official Josef Silny evaluation of all high school and/or higher education course work from International schools (www.jsilny.com) Proof of Immunization Post-Baccalaureate/Second Degree (an applicant who already has earned a bachelor's degree from an accredited college or university and wishes to earn another bachelor's degree from GSW) q Completed application with $25 non-refundable fee q Official copies of transcripts from each college attended q Proof of Immunization MAJORS AND PROGRAMS Accounting Art Biology Chemistry Computer Science Dramatic Arts - Communications and Media Arts Dramatic Arts - Design and Technology Dramatic Arts - Performance Early Childhood Education English English with Professional Writing Option English with Teacher Certification Exercise Science/Wellness Geology Health and Physical Education History History with Teacher Certification Human Resource Management Information Technology - Business Option Information Technology Multi-Media Option Information Technology - Professional Writing Option Management Marketing Mathematics Mathematics with Teacher Certification Middle Grades Education Music - Choral Music - Instrumental Music - Piano Music with Teacher Certification Nursing - Accelerated Track (for those who already have a 4 year college degree) Nursing - LPN to BSN (must have earned LPN prior to enrollment) Nursing - RN to BSN (must have Associates degree in Nursing) Nursing - Traditional Track Political Science Political Science with Teacher Certification Psychology Sociology Special Education ABAC - Accounting ABAC - Early Childhood ABAC - Management East Ga College - Accounting East Ga College - Management Middle Ga College - Accounting Middle Ga College - Management South Ga College - Accounting South Ga College - Management Bainbridge College - Accounting Bainbridge College - Management Georgia Perimeter - Accounting Georgia Perimeter - Management Waycross College - Accounting Waycross College - Management Pre-Occupational Therapy Pre-Optometry Pre-Pharmacy Pre-Physical Therapy Pre-Physician’s Assistant Pre-Veterinary CERTIFICATE PROGRAMS Caregiving Specialist Criminal Justice European Union Studies Professional Golf Management Web Design Women's Studies Scan to apply online PRE-PROFESSIONAL PROGRAMS Engineering (dual-degree in conjunction w/ Georgia Tech) Pre-Dentistry Pre-Law Pre-Medical Technology Pre-Medicine Georgia Southwestern State University is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools (1866 Southern Lane, Decatur, Georgia 30033-4097: Telephone number 404-679-4501) to award associate, baccalaureate, master’s and specialist degrees. APPLICATION for UNDERGRADUATE ADMISSION Office of Undergraduate Admissions Georgia Southwestern State University 800 Georgia Southwestern State University Drive Please Print Clearly Americus, Ga 31709 admissions@gsw.edu www.gsw.edu Use Ink or Type I. PERSONAL INFORMATION Social Security Number Date of Birth Georgia Southwestern is allowed by law to request and use the Social Security Number according to federal and state guidelines. While you are not required to provide your Social Security Number, you are encouraged to do so. Your SSN is required for financial aid, educational tax benefits, and possible other purposes. This information may be disclosed only under certain circumstances. Full Legal Name ______________________________________ Name on Transcript _________________________ LAST FIRST MIDDLE (If different from legal name) Mailing Address ___________________________________________________ Home Phone (____)_____________ STREET OR P.O. BOX __________________________________________________________________ Cell Phone (____)_______________ CITY STATE COUNTY Permanent Address (if same as above, please check) ZIP CODE _____________________________________ STREET Home Phone (____)_____________ __________________________________________________________________Work Phone (____)______________ CITY Email Address STATE COUNTY ZIP CODE (please print clearly)________________________________________________________________________ Emergency Contact: Name_________________________________________ parent guardian spouse other Address_________________________City_____________State____Zip______ Home Phone (_____)_______________ Work Phone (____)________________ GSW is required to report gender and race/ethnicity information to certain federal and state agencies as this data relates to civil rights compliance Are you Hispanic? What is your race? Yes No (choose one or more) Gender: American Indian Male Female Alaska Native Asian Native Hawaiian or other Pacific Islander Have you ever been convicted or have charges pending of any criminal offense other than a minor traffic violation? If yes, attach a detailed explanation. Black or African American White Yes No Have you ever been disciplined, suspended or expelled or do you have pending charges from another high school, college or university? Yes No If yes, attach a detailed explanation. Official transcripts from EACH previous college attended must be mailed directly to the Admissions Office from the sending institution. Are any of your family members alumni of GSW? Yes No If yes, name(s) and relationship: ______________________________________________________________ Father’s highest education completed:______________ Mother’s highest education completed:______________ II. ENROLLMENT INFORMATION Applying as: Beginning Freshman Transfer Non-Traditional Freshman Transient Second Degree / Post-Baccalaureate Accel/Joint Enrollment Personal Development Academic Major of Interest: __________________________________________ I am undecided at this time. Please use the list from the front page Site: GSW Waycross Bainbridge East Georgia Online Middle Georgia South Georgia Georgia Perimeter Other campus:_________________________________________ Term you plan to attend: Fall Spring Summer Year_________ Name City/State Yrs. Attended from Graduation to month/year Degree earned Last High School Attended Last College Attended** Previous College Previous College Please attach other colleges attended to this application if more room is needed. **Are you currently enrolled at your last college?_______________ Otherwise, the application will be considered incomplete. Failure to list all school information will impact acceptance. Have you taken the SAT? Yes No Date Taken______Critical Reading Score____Math Score____Writing Score_____ Have you taken the ACT? Yes No Date Taken______Composite Score________Math Score____English Score_____ What courses are you currently taking this year? ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Have you applied to this institution before? Have you ever attended this institution before? Yes Yes No If yes, ______ / _______ No If yes, ______ / _______ How did you first learn about Georgia Southwestern?__________________________________________________ III. TUITION CLASSIFICATION INFORMATIOIN Citizenship Status: U.S. Citizen by Birth U.S. Citizen by Naturalization Alien, Non-Resident Permanent Resident* (*Please attach copy of both sides of Alien Registration Receipt Card I-15) Country of Citizenship (if not U.S.A.) ____________________________ Place of Birth:________________________ Are you applying for In-State Tuition? Yes No How long have you established and maintained domicile in Georgia?______yrs ______mos How long have you lived in the USA?______yrs _______mos County of Residence: ________________________ CITY STATE Have you established and maintained legal residence in Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term in which you plan to enroll? Yes No If you are under the age of 24, has a parent(s) or US court-appointed legal guardian established and maintained legal residence and domicile in Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term in which you plan to enroll? Yes No Will you need an I-20 Certificate of Eligibility? Yes No If you answered "yes" to either of the above, all of the following must be answered: What is your Georgia county of residence?______________________________ Have you ever lived outside of the state of Georgia? If you have ever lived outside the state of Georgia and now live in Georgia, how long have you continuously lived in the state of Georgia at this time? _________years __________months Have you graduated or will you graduate from a Georgia high school? Yes No Yes No Did you (or your parents if you are claimed as a dependant) file a state income tax return this past year? If yes, in which state did you file?_________________ From what state is your driver's license issued?____________________________ From what state is your motor vehicle registration issued? ________________________ From what state is your voter registration issued?___________________________ Yes No IV. MILITARY INFORMATION Are you currently active duty, a veteran, a member of the National Guard, or a Reservist in the United States Armed Forces? Yes No If yes, answer the following questions: Which branch of the military do/did you serve? ______________________________________________________________ Specify: Active Duty Veteran What is your home state of record? ____________________ Are you stationed or assigned to Georgia?_________________ Are you the spouse or dependent child under the age of 24 of someone who is currently active duty, a veteran, a member of the National Guard, or a Reservist in the U.S. Armed Forces? Yes No Is the military member active duty, a veteran, a member of the National Guard, or a Reservist? ________________________ What is the military member’s branch?_________________________ Specify: Active Duty What is the military member’s home state of record? ______________________ Is the military member stationed or assigned to Georgia?__________________ Veteran I understand that any material false statement made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution. Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete. DATE_____________________ SIGNATURE OF APPLICANT______________________________________ Send this application with a $25.00 processing fee to: Georgia Southwestern State University • 800 Georgia Southwestern State University Drive Americus, GA 31709 • 1-800-338-0082 •www.gsw.edu Georgia Southwestern State University, a senior unit of the University System of Georgia, is an equal opportunity, affirmative action, educational institution and as such does not discriminate in any matter concerning students, employees, or services to its community on the basis of race, color, religion, sex, veteran status, disability, age, or national origin.
