UTAH VALLEY UNIVERSITY

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OnlineApplication
Pleaseenteryourinformationineachofthefollowingsections.Fieldswitharedasterisk(*)arerequiredand
mustbecompletedbeforeyoucansubmityourapplication.Additionalquestionsmaybecomerequired
basedonyouranswerstoapreviousquestion.

NameandEmailAddress
FirstName *

MiddleName

Shaye

Colleen

LastName *

Dumas
EmailAddress *

shayedumas@gmail.com

AgeCertification
Studentsundertheageof17yearsmustcontacttheOfficeofAdmissionsbeforeadmittancetoUtahValley
University.Pleasecall8018638706oremailadmissions@uvu.edufordetails.
IfyouareapplyingfortheHighSchoolConcurrentEnrollmentprogram,clickheretoreturntotheapplication
menuandselecttheHighSchoolConcurrentEnrollmentapplication.

Iamatleast17yearsold *
Bytypingyesintheboxbelow,youareaffirmingthatyou
areatleast17yearsold.

yes

DemographicInformation
Gender *

Female
CitizenshipStatus *

SocialSecurityNumber *

USCitizen

EnteryourSocialSecurityNumberas9numberswithout
dashes.

647421357
BirthCountry *

BirthState/Province *

UnitedStates

Utah

BirthCity *

BirthDate *

SaltLakeCity

(mm/dd/yyyy)

7/21/1998

TheUniversityhasbeenaskedbytheState/Federalgovernment,accreditingassociations,andforinternal
reportingtodescribetheracial/ethnicbackgroundsofourstudentsandemployees.Theinformationyouprovide
inthissectionwillnotbeusedinadiscriminatorymanner.

Ethnicity

NonHispanic/Latino
Regardlessofyouranswertothepriorquestion,pleasecheckoneormoreofthefollowinggroupsinwhichyou
consideryourselftobeamember:

AmericanIndian

No
AlaskanNative

No

Asian

No
BlackorAfricanAmerican

No
NativeHawaiian

No
PacificIslander

No
WhiteorCaucasian

Yes

Pleaseenteryourinformationineachofthefollowingsections.Fieldswitharedasterisk(*)arerequiredand
mustbecompletedbeforeyoucansubmityourapplication.Additionalquestionsmaybecomerequired
basedonyouranswerstoapreviousquestion.

PermanentAddress
CheckifaddressisoutsideofU.S.orCanada

No
Address *

416EWoodlakeLnApt172
Address(cont)

City *

SaltLakeCity
State/Province *

Zip/PostalCode *

Utah

841071650

PermanentAddressTelephone
Phone *
Pleaseenteryourphonenumberinthefollowingformat
(xxx)xxxxxxx

(801)4037122

LocalorCurrentMailingAddress
CheckifaddressisoutsideofU.S.orCanada

No
Address *

416WoodlakeLnApt172
Address(cont)

City *

SaltLakeCity

State/Province *

Zip/PostalCode *

Utah

84107

LocalAddressTelephone
Telephone *

Pleaseenteryourphonenumberinthefollowingformat
(xxx)xxxxxxx

(801)4037122

Pleaseenteryourinformationineachofthefollowingsections.Fieldswitharedasterisk(*)arerequiredand
mustbecompletedbeforeyoucansubmityourapplication.Additionalquestionsmaybecomerequired
basedonyouranswerstoapreviousquestion.

EntryTermandPlannedProgramofStudy
AdmitType *

Freshman

AnticipatedEntryTerm *

2016FALL
ProgramofStudy *

CriminalJusticeLawEnforcementBS

HighSchoolInformation1
IfyourhighschoolisNOTLISTEDpleaseselectUtahasthestateandDONOTINPUTACITY.Therewillbean
optionforOTHERINSTATEHIGHSCHOOLorOUTOFSTATE.
IfyouattendedhighschooloutsidetheUnitedStatesselectOutsidetheUnitedStates,asthecountryandplease
DONOTINPUTACITY.Whenyouclicksearch,anoptionforOUTOFCOUNTRYHIGHSCHOOLwillbeavailable.
IfyouhavereceivedaGEDorHOMESCHOOLdiploma,pleasechooseUtahastheStateandDONOTINPUTA
CITY,thesechoicesarelistedunderUtahhighschools.

HighSchool

AMESAcademyForMathEngSci(450360)

DateofHIGHSCHOOLgraduation *
(mm/dd/yyyy)

5/26/2016

TShirtSize
(Enteringyourtshirtsizeisoptionalanddoesnotguaranteedeliveryofatshirt.Usedinternallyforpromotionalgiveaways.Subjectto
availability.)

Medium

TheinformationintheResidencysectionisusedtomakeaninitialresidencyclassification.

Residency
InformationintheResidencySectionisrequiredtomakeaninitialresidencyclassificationatUVU.
Enteringincompleteinformationorfalsifyinginformationwillresultinaninaccurateresidency
classificationand/orholdsonyourrecord.

StateofLegalResidency
FailuretoaccuratelyreportyourDriver'sLicenseorStateIDinformation,willresultinbeingassignedNon
ResidenceStatus.

State/ProvinceIclaimlegalresidencyof *

Utah
Howlongyouhavecontinuouslylivedinthe
abovestate/province *

Morethan5years
DoyouhaveaDriversLicenseorStateID *

Yes

State/ProvinceDriversLicense/StateIDis
issuedin *

Utah

DriversLicense/StateIDNumber *

213135726

DateDriversLicense/StateIDwasissued *
(mm/dd/yyyy)

8/5/2014

Activityfortheprevious3years
Enteryouractivityfortheprevious3yearsuptothecurrentdate(entermorethanoneactivityif
necessary).Enteringlessthan3yearsofactivitywillresultinaclassificationofnonresident.

Activity1 *

School
CountryofActivity *

State/ProvinceofActivity *

UnitedStates

Utah

ActivityFromDate *

ActivityToDate *

(mm/dd/yyyy)

(mm/dd/yyyy)

8/26/2013

10/30/2015

Activity2

Working
CountryofActivity2 *

State/ProvinceofActivity2 *

UnitedStates

Utah

Activity2FromDate *

Activity2ToDate *

(mm/dd/yyyy)

(mm/dd/yyyy)

5/26/2015

10/30/2015

Activity3

CountryofActivity3

Activity3FromDate

Activity3ToDate

(mm/dd/yyyy)

(mm/dd/yyyy)

EmergencyContact
Relationship *

Mother
EmergencyContactFirstName *

EmergencyContactLastName *

Jaime

Attkisson

EmergencyContactaddressoutsideofU.S.orCanada?

No
EmergencyContactAddress *

416WoodlakeLn
EmergencyContactAddressLine2

Apt172
EmergencyContactCity *

SaltLakeCity
EmergencyContactState/Province *

EmergencyContactZip/PostalCode *

Utah

84107

EmergencyContactPhone *
Pleaseenteryourphonenumberinthefollowingformat
(xxx)xxxxxxx

(801)6343970

ParentContactInformation
Inadditiontotheemergencycontactlistedabove,youcanalsolistaparentasacontact.

GiveParentContactInformation?

Yes

ParentRelationship

Father
ParentFirstName

ParentLastName

Bryan

Dumas

Parentlivesatsameaddress?
Ifyourparentsaddressisthesameasyourpermanentaddress,selectyesandskiptoParentPhone.Otherwise,pleaselistyour
parentsaddress.

No
CheckifaddressisoutsideofU.S.orCanada

No
Address

35174West9280South
Address(cont)

City

Duchesne
State/Province

Zip/PostalCode

Utah

84021

ParentPhone
Pleaseenteryourphonenumberinthefollowingformat
(xxx)xxxxxxx

(435)7247303

OtherInformation
Areyoucurrentlyincarcerated?

No
Father'sEducation *

Mother'sEducation *

Somecollegebutnoformalaward

Associate'sdegree

Doyouplantointerruptyourschooling *
DoyouplantointerruptyourschoolingtoserveintheMilitary,ForeignService,orChurchrelatedmissionduringthenextyear?

No
Myeducationalgoal *

FourYearDegree
AreyoucurrentlyorhaveyoueverservedintheUnitedStatesArmedForces? *

No

IsyourspousecurrentlyorhavetheyeverservedintheUnitedStatesArmedForces?

No
AreyouthedependentofanyonecurrentlyorthathaseverservedintheUnitedStatesArmedForces?

No

Certification
Pleaseaffirmthefollowingbeforeyousubmityourapplication.

Doyoucertifythefollowing? *
IunderstandthatoncemyapplicationhasbeensubmitteditmayNOTbealteredinanyway.Iunderstandthatwithholdinginformation
requestedonthisapplication,includingattendanceatanyotherinstitution,orgivingfalseinformationmaymakemeineligibletothe
universityorsubjecttodismissal.
IhavereadthisapplicationandcertifythatthestatementsthatIhavemadeonthisapplicationarecorrectandcomplete,includinga
reportofallcollegeworkattemptedorcompleted.

Yes
Doyoucertifythefollowing? *
Iagreetopayanyapplicationfeeassociatedwiththisapplicationandunderstandthatthefeeisnotrefundable.

Yes
Doyoucertifythefollowing? *
IvoluntarilyconsenttoreceiveelectroniccommunicationviamyUVLinkemailfromtheFinancialAidandScholarshipOffice.I
understandIcanrescindthisvoluntaryconsentbycontactingtheFinancialAidandScholarshipOffice.

Yes
Theelectronicsignatureconsistssimplyofyourname,typedbyyouonyourkeyboard.Thesignatureisyour
confirmationthattheapplicationyouhavefilledoutisyourownworkandtheinformationisfactuallytrue.Once
youtypeinyourname,thiswillcountasyourelectronicsignature.

Signature *

SignatureDate *

ShayeDumas

10/30/2015

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