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OFFICE OF ADMISSIONS
Chicago State University
COOK ADMINISTRATION BUILDING
9501 SOUTH KING DRIVE / ADM 200
CHICAGO, ILLINOIS 60628-1598
PHONE (773) 995-2513
FAX (773) 995-3820
ug-admissions@csu.edu
www.csu.edu
Reinstatement Applicants
• Former undergraduate students who have been dismissed from the university for QUESTIONS ABOUT CHICAGO STATE?
poor scholastic achievement and have been away from the university for more than
one semester must present a written petition addressed to the Office of Admissions For tour information, please call the Office of Admissions at
with this application. Official transcripts for work completed since leaving Chicago (773) 995-2513. Send all application materials:
State University must also be received by the Office of Admissions before any
Office of Admissions
action can be taken on the application. (Petition forms are available in the Office of
Chicago State University
Admissions and the Office of Records and Registration.)
9501 South King Drive / ADM 200
• Deadline dates - contact the Office of Admissions web page.
Chicago, Illinois 60628-1598
Undergraduate-at-Large (Visiting Students)
For more information, visit our website: www.csu.edu
• For an undergraduate-at-large application, please contact the Office of
Admissions, or visit our website: www.csu.edu/Admissions. Do not use this
If you require accommodation due to a disability in order to complete the
application!
application process, please contact the ADA Coordinator, Abilities Office,
• Individuals without a Bachelor’s degree who can demonstrate good academic
SUB 198, (773) 995-4401, TTY (773) 995-3776. Please allow sufficient
standing (C average) at their last regionally accredited college or university may
time to arrange for accommodation.
attend Chicago State University as an undergraduate-at-large student.
• Applicants may submit to the Office of Admissions a transcript, letter of good
standing from the registrar, or the most recent grade report with the cumulative
grade point average.
Financial Assistance
• Degree seeking students should apply for financial aid by the priority deadline of
March 15. FAFSA code 001694 at http: //www.FAFSA.ed.gov/
Term you are applying for Admission: FALL (August)/Year ______ SPRING (January)/Year ______ SUMMER (May/June)/Year _______
Mr. Ms. Mrs. Last Name: _______________________ First Name:_______________________ M.I.: __________
Former Name(s) ________________________________________________________________
Permanent Address: Apt. No.__________ Number and Street__________________________________________________
City________________________________________________ State_______________ Zip__________________
Mailing Address: Apt. No.__________ Number and Street__________________________________________________
City________________________________________________ State_______________ Zip__________________
-
££££££££££££
Day Phone: Eve. Phone: -
££££££££££££
Cell Phone: -
££££££££££££
E-mail Address: ££££££££££££££££££££££££££££££££££
Birthdate: Month ______________ Day ______ Year _________ Male Female. Marital status Single Married
Ethnic and Racial Identification for U.S. Citizens & Permanent Residents only (optional)
Your response to these items is voluntary. Please enter your ethnic and racial identification information to help the University meet its federal reporting
obligations. First, identify whether or not your ethnicity is Hispanic or Latino, regardless of race. Second, select one or more races from the five racial groups.
Ethnic Identification Hispanic or Latino Not Hispanic or Latino
(select one)
Racial Identification American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
(select all that apply)
Residency: How long have you been an Illinois resident? ____ Year(s) ____ Month(s) County_______________________________
Citizenship: U.S. Citizen (skip to next section ) If not a citizen, indicate country of citizenship _________________________________
Permanent Resident ALIEN RESIDENT NUMBER:____________________________________________________
Permanent Residents must submit a copy of both sides of their Alien Registration Receipt Card.
Requesting consideration under Illinois Public Act 93-007. Asylee (submit documentation) Refugee (submit documentation)
Military Service: Have you completed at least one year of active duty in the U.S. Military? Yes No
Phone: -
££££££££££££
Relationship: Parent Guardian Spouse Other_________
Intended Major Code: (see back page)______________________ NOTE: We cannot process without a valid Chicago State University Major Code!
Have you previously applied to this institution? No Yes…Indicate Term __________________________ Year _____________
Were you admitted? No Yes…Indicate Term __________________________ Year _____________
Did you enroll? No Yes…Indicate Term __________________________ Year _____________
John ADMISH 2009 102210.indd 12/30/10
HIGH SCHOOL INFORMATION
Name of high school from which you graduated/will graduate: ______________________________________________________
Graduation/Date: Month __________________ Year _______ City _______________________________ State _________
Check here if you completed the GED instead of graduating from high school.
COLLEGE INFORMATION
_________________________________________________________________________________________
List all colleges, universities and proprietary schools Attendance Dates
College Credits/
Degrees
attended (including this university), beginning with City/State
From To hours earned earned
the most recent. You must send official transcripts Month/Year Month/Year
from each institution attended.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
CERTIFICATION
This certification MUST be signed and dated by the applicant in order for this application to be processed.
I understand that withholding information requested on this application, including attendance at any other institution or giving false information, may
make me ineligible for admission to the University or subject to dismissal if admitted. I have read and understand all instructions and information on this
application and certify that the statements I have made on this application are correct and complete.
Signature____________________________________________________ Date___________________________
Applications received after the priority processing deadline date will be accepted, only with all supporting documents.
A $25 non-refundable application fee must be submitted with the application.
Applicants with fee waivers will be assessed a processing fee of $25.00 upon enrollment.