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universal

universal First-Year Admissions Application


First-Year Admissions Application
college application
college application

This
This form
form is
is developed
developed for,
for, and
and is
is to
to be
be used
used by,
by, the
the members
members of
of the
the Universal
Universal College
College Application.
Application. All
All members
members evaluate
evaluate this
this form
form equally
equally with
with all
all other
other forms
forms
This formby
accepted
accepted byisthe
developed
the for, and
institution.
institution. is to
Please
Please be used
type
type or by, the
or print
print members of the Universal College Application. All members evaluate this form equally with all other forms
neatly.
neatly.
accepted by the institution. Please type or print neatly.
College
College Name
Name Regular
Regular Decision
Decision II Early
Early Decision
Decision II
College Name Regular Decision
Regular Decision II
II Early
Early Decision
Decision II
II
II am
am applying
applying for
for the
the term
term beginning
beginning Restrictive Early Action Early Action
I am applying for the term beginning
Possible
Possible Major
Major Possible
Possible Career
Career Plans
Plans
Possible Major Possible Career Plans

payment information
payment information
Are
Are you
you planning
planning to
to apply
apply for
for aa counselor-approved
counselor-approved fee
fee waiver?
waiver? Yes
Yes No
No Are
Are you
you applying
applying for
for financial
financial aid?
aid? Yes
Yes No
No
Are you planning to apply for a counselor-approved fee waiver? Yes No Are you applying for financial aid? Yes No
If
If you
you are
are applying
applying for
for financial
financial aid,
aid, when
when did/will
did/will you
you file
file the
the appropriate
appropriate form(s)
form(s) (FAFSA,
(FAFSA, CSS
CSS Profile,
Profile, etc.)?
etc.)?
If you are applying for financial aid, when did/will you file the appropriate form(s) (FAFSA, CSS Profile, etc.)?

personal information
personal information
Please
Please enter
enter your
your name
name as
as it
it appears
appears on
on your
your passport
passport or
or otherother official
official documents.
documents.
Please enter your name as it appears on your passport or other official documents.
Legal
Legal Name
Name Male
Male Female
Female
Legal Name Last
Last (F
(Faam
miillyy)) FFiirrsstt M
Miiddddllee SSuuffffiixx ((JJrr..,, SSrr..,, eettcc..)) Male Female
Last (Family) First Middle Suffix (Jr., Sr., etc.)
Preferr
Preferreedd N Naam mee PPrreevviioouuss LLaasstt N Naammee((ss)),, iiff aannyy
Preferred Name Previous Last Name(s), if any
D
Daattee ooff B
Biirrtthh SSoocciiaall SSeeccuurriittyy N
Nuum
mbbeerr ((ooppttiioonnaall))
Date of Birth (mm/dd/yyyy)
(mm/dd/yyyy) Social Security Number (optional) (###-##-####)
(###-##-####)
(mm/dd/yyyy) (###-##-####)
Email
Email Marital
Marital Status
Status
Email Marital Status (single,
(single, married,
married, etc.)
etc.)

permanent address (single, married, etc.)

permanent address
Street
Street Address
Address Apt.
Apt. ##
Street Address Apt. #

C
Ciittyy//T
Toow
wnn SSttaattee//PPrroovviinnccee C
Coouunnttrryy ZZiipp//PPoossttaall C
Cooddee
City/Town State/Province Country Zip/Postal Code
Phone
Phone A
Alltteerrnnaattee PPhhoonnee
Phone ( Begin
Begin with
with Area
Area
) or
or Country
Country Code
Code Alternate Phone ( Begin
Begin with
with Area
Area
) or
or Country
Country Code
Code
Begin with Area or Country Code Begin with Area or Country Code

Please
Please give
give your
your current
current address
address for
for all
all admission
admission correspondence,
correspondence, ifif different
different from
from above.
above.
Please give your current address for all admission correspondence, if different from above.
current mailing address
current mailing address
Street
Street Address
Address Apt.
Apt. ##
Street Address Apt. #

City/Town
City/Town SSttaattee//PPrroovviinnccee C
Coouunnttrryy ZZiipp//PPoossttaall Code
Code
City/Town State/Province Country Zip/Postal Code
Current
Current Mailing
Mailing Address
Address Phone
Phone C
Cuurrrreenntt m
maaiilliinngg aaddddrreessss vvaalliidd ffrroom
m ttoo
Current Mailing Address Phone ( Begin
Begin with
with
) Area
Area or
or Country
Country Code
Code Current mailing address valid from (mm/dd/yyyy)
(mm/dd/yyyy) to (mm/dd/yyyy)
(mm/dd/yyyy)
Begin with Area or Country Code (mm/dd/yyyy) (mm/dd/yyyy)

citizenship
citizenship
Place
Place of
of Birth
Birth
Place of Birth City/Town
City/Town State/Province
State/Province Country
Country
City/Town State/Province Country
US
US Citizen
Citizen Dual
Dual US
US citizen;
citizen; please
please specify
specify other
other country
country of
of citizenship
citizenship
US Citizen Dual US citizen; please specify other country of citizenship
US
US permanent
permanent resident
resident visa;
visa; citizen
citizen of
of Alien
Alien registration
registration number
number
US permanent resident visa; citizen of Alien registration number
Other
Other Citizenship
Citizenship
Other Citizenship Visa
Visa
Visa
If
If you
you live
live in
in the
the United
United States,
States, but
but are
are not
not aa U.S.
U.S. citizen,
citizen, how
how many
many years
years have
have you
you lived
lived in
in the
the country?
country?
If you live in the United States, but are not a U.S. citizen, how many years have you lived in the country?
If
If not
not English,
English, language
language spoken
spoken inin your
your home
home If
If not
not English,
English, list
list your
your first
first language
language
If not English, language spoken in your home If not English, list your first language
ApplicationsOnline
ApplicationsOnline 2015
20072015
2015 Universal
Universal
Universal
College
College
College
Application
Application
Application first-year
first-year admissions
admissions application
application 11
ApplicationsOnline 2015 Universal College Application first-year admissions application 1
ethnicity
Race/Ethnicity information is optional. Information you provide will not be used in a discriminatory manner.

Are you Hispanic or Latino? Yes No (country of familys origin )

How would you describe your racial background? (select one or more of the following categories):

Asian (country of familys origin ) Native Hawaiian or Other Pacific Islander


Black or African American White
American Indian or Alaska Native (enrolled )
Tribal affiliation )

family information
parent/guardian #1
Parent Guardian
Title Last (Family) First Middle Suffix

Male Female Living? Yes No (Date Deceased )


(mm/yyyy)

If different from yours


Address
Street Address Apt. #

City/Town State/Province Country Zip/Postal Code

Phone Email
Begin with Area or Country Code

Profession Position

Employer

College Attended (if any) Degree Earned Year

Graduate School Attended (if any) Highest Degree Earned Year

parent/guardian #2
Parent Guardian
Title Last (Family) First Middle Suffix

Male Female Living? Yes No (Date Deceased )


(mm/yyyy)

If different from yours


Address
Street Address Apt. #

City/Town State/Province Country Zip/Postal Code

Phone Email
Begin with Area or Country Code

Profession Position

Employer

College Attended (if any) Degree Earned Year

Graduate School Attended (if any) Highest Degree Earned Year

Your parents are If divorced, list date


(married, divorced, etc.) (mm/yyyy)

With whom do you reside? Both Parent/Guardian#1 Parent/Guardian#2 Other (Explain)

List names, genders, and ages of your siblings, college (if any), degree(s), and dates of attendance.
Name Gender Age Institution Degree(s) Dates

ApplicationsOnline 20072015 Universal College Application first-year admissions application 2


academic information
School CEEB Code

Type of school: Public Private Correspondence Charter Parochial Home-School Other/Education Provider

School Address
Number and Street

City/Town State/Province Country Zip/Postal Code

Start Date Date of Graduation


(mm/yyyy) (mm/yyyy)

Counselors Name Phone


Begin with Area or Country Code

Counselors Email Fax


Begin with Area or Country Code

Are you currently enrolled in school? Yes No Will/did you graduate from High School early? Yes No

Did you receive a GED? Yes No If so, list date: (Please send official scores from testing agency)
(mm/yyyy)

If your education has been interrupted, please detail your activities since last enrolled. Please attach your response to the end of the application.

current years courses


Please list name, level (Honors, AP, IB, etc.) and credit value of your current years courses.

Semester #1/Trimester #1 Semester #2/Trimester #2 Trimester #3

List all other high schools, colleges/universities (including summers), and academic programs you attended, beginning with ninth grade.
You must submit transcripts from each school.

other high schools


School Name CEEB Code Dates Attended Location

colleges/universities
School Name CEEB Code Dates Attended Location

ApplicationsOnline 20072015 Universal College Application first-year admissions application 3


ap/ib test scores
Please list any Advanced Placement or International Baccalaureate exams taken along with the test date and score.

ap/ib testSubject
Test Date scores Score Test Date Subject Score
ap/ib test scores
Please list any Advanced Placement or International Baccalaureate exams taken along with the test date and score.
Please
Test Datelist any Advanced Placement or International Baccalaureate
Subject exams taken alongTest
Score with the test date andSubject
Date score. Score

Test Date Subject Score Test Date Subject Score


Test Date Subject Score Test Date Subject Score

Test Date Subject Score Test Date Subject Score


Test Date Subject Score Test Date Subject Score

standardized
Test Date
Subject test information
Score Test Date Subject Score
Test Date Subject Score Test Date Subject Score

List your test scores below. You must have the testing agency send official scores to each institution to which you are applying.

standardized
SAT Reasoning test information
standardized
Test Date
test information
Verbal/
Critical Reading
Math Writing Test Date Verbal/
Critical Reading
Math Writing

List your test scores below. You must have the testing agency send official scores to each institution to which you are applying.
List your test scores below. You must have the testing agency send official scores to each institution to which you are applying.
Test Date Verbal/ Math Writing
Critical Reading
SAT Reasoning
SAT Reasoning Test Date Verbal/ Math Writing Test Date Verbal/ Math Writing
Test Date Critical Reading
Verbal/ Math Writing Test Date Critical Reading
Verbal/ Math Writing
Critical Reading Critical Reading
SAT Subject
Test
Test Date
Date Subject
Verbal/ Math Score
Writing Test Date Subject Score
Test Date Critical Reading
Verbal/ Math Writing
Critical Reading

Test Date Subject Score Test Date Subject Score

SAT Subject
SAT Subject Test Date Subject Score Test Date Subject Score
Test Date Subject Score Test Date Subject Score

Test Date Subject Score Test Date Subject Score


Test Date Subject Score Test Date Subject Score

ACT
Test Date
Test Date English
Subject Math
Score Reading
Test Date Science
Subject Composite
Score Combination
English/Writing
Test Date Subject Score Test Date Subject Score

Test Date English Math Reading Science Composite Combination


English/Writing
ACT
ACT Test Date English Math Reading Science Composite Combination
Combination English/Writing
Test Date English Math Reading Science Composite English/Writing
Combination
Writing Subject Score
English/Writing

Test Date English Math Reading Science Composite Combination


Combination English/Writing
English/Writing
Test of English as a Test Date English Math Reading Science Composite Combination
Writing Subject Score
English/Writing
Foreign Language Test Date Subject Score Test Date Subject Score

(TOEFL or other exam)Test Date English Math Reading Science Composite Combination
Combination English/Writing
Test Date English Math Reading Science Composite English/Writing
Combination
Writing Subject Score
English/Writing

Test of English as a
Test of English
Foreign Languageas a Test Date Subject Score Test Date Subject Score
academic distinctions
Foreign Language
(TOEFL or other exam)
Test Date Subject Score Test Date Subject Score

(TOEFL or other exam)


Please list any academic or educational awards and honors you received in high school (e.g. National Merit, National Honor Society).
Please attach your response to the end of the application.

academic distinctions
academic distinctions
Please list any academic or educational awards and honors you received in high school (e.g. National Merit, National Honor Society).
Please
Please list anyyour
attach academic or educational
response to the end ofawards and honors you received in high school (e.g. National Merit, National Honor Society).
the application.
Please attach your response to the end of the application.

ApplicationsOnline 2015
20072015
Universal
Universal
College
College
Application
Application first-year admissions application 4
extracurricular and volunteer information (including summer)

Please list any significant extracurricular or community activities and hobbies in which you have participated. Include specific accomplishments such as musical
accolades, athletic distinctions, etc. (Please note: PG means Post-Graduate)

Activity Grade Level Specific Accomplishments Hours/ Weeks/ Will you participate
Week Year in college?

9 10 11 12 PG | Yes No Unsure

9 10 11 12 PG | Yes No Unsure

9 10 11 12 PG | Yes No Unsure

9 10 11 12 PG | Yes No Unsure

9 10 11 12 PG | Yes No Unsure

9 10 11 12 PG | Yes No Unsure

9 10 11 12 PG | Yes No Unsure

employment information
List any work experience (including summer jobs) during the past three years.

Employer Job Description Dates of Employment Hours per week

activity description
Tell us more about one of your extracurricular, volunteer, or employment activities (100-150 words). If you need more space, please attach your response to the
end of the application.

ApplicationsOnline 20072015 Universal College Application first-year admissions application 5


personal statement
Please write an essay (650 words or fewer) that demonstrates your ability to develop and communicate your thoughts. Some ideas include: a person you admire;
a life-changing experience; or your viewpoint on a particular current event. Please attach your response to the end of your application.

multimedia information
Optional: You may provide your selected college(s) with a link to any online content you feel:
1. Tells the college more about yourself 2. Demonstrates a particular talent you possess 3. Highlights an activity in which you participated

Some ideas include linking to an online video you created, a portfolio (pictures or photographs), a musical composition, or a newspaper article.

http://

Please briefly describe the contents of the link you provided.

additional information
If you have additional information that was not specifically requested on the application or did not fit in the space provided, feel free to include it here.
If you need more space, please attach your response to the end of the application.

discipline information
Have you ever been placed on probation, suspended, removed, dismissed or expelled from any school Yes No
or academic program since 9th grade?

Other than traffic offenses, have you ever been convicted of any misdemeanor, felony, or other crime? Yes No

If you answered yes to either question, please provide an explanation and the approximate dates of each incident.
Please attach your response to the end of the application.

authorization
Your signature below

1. authorizes all schools you attended to provide all requested records and allow review of your application for the admission process chosen on this application.

2. confirms all information in this application (including any supplemental information) is factually true and honestly presented and that you are the person
submitting this application.

Signature of applicant Date

ApplicationsOnline 20072015 Universal College Application first-year admissions application 6

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