Documente Academic
Documente Profesional
Documente Cultură
First/Given Name
Middle Name
Gender:
q Male
q Female
Ethnic Origin
Colleges and universities are asked by many groups and agencies, including federal, state and local governments, to describe the racial/ethnic
back-grounds of their students. In order to help us respond to these surveys and to report this information, please answer both questions.
1. Are you of Hispanic or Latino origin? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or
origin, regardless of race) q Yes q No
2. What is your race? Select one or more of the following categories, as appropriate: (The definitions above and below are provided by the
National Center for Education Statistics.)
q White (A person having origins in any of the original peoples of Europe, the Middle East or North Africa)
q Black or African American (A person having origins in any of the black racial groups of Africa)
q Asian (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for
example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam)
q American Indian or Alaska Native (A person having origins in any of the original peoples of North and South America, including
Central America, and who maintains cultural identification through tribal affiliation or community attachment)
q Native Hawaiian or Other Pacific Islander (A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other
Pacific Islands)
Number and Street/Box No.
County
State
ZIP/Postal Code
Country
Home Phone
Cell Phone
Email: ___________________________________________________
Family Information
Name of
q Parent(s)
q Guardian
q Spouse: _________________________________________________________________
Number and Street/Box No.
Apt. No.
County
State
ZIP/Postal Code
Country
Home Phone
Section 3. Citizenship
Are you a U.S. citizen? q Yes q No (if Yes, please skip to section 4)
If you are not a U.S. citizen, please complete this section. If you hold a visa or permanent resident card, are a refugee, or have been granted asylum, provide
photocopies of the documents you have been issued. Photocopy the front and back of the permanent resident card.
Foreign Address
___________________________________________________________________________________
____________________________________________________________________________________
City ________________________ Country ____________________________
Telephone Number _____________________________
q No
q No
q No
Do you need Early Out papers to be prepared in order to attend Towson University? q Yes
q Yes
q Yes
q No
q Yes
q No
q No
Are you or have you been a reservist in the US Armed Services, including the National Guard q Yes
q No
q No
Academic Plan
Indicate the major you wish to pursue: ______________________________________________________________________________
Financial Aid Plans
q Will apply for financial aid (The FAFSA is required for financial aid. Additional information is available online at www.towson.edu/finaid.)
High School History
___________________________________________________________________________________
High school currently attending (or from which you graduated)
City
State
______________________
ETS code number
Year
Month
Year
Month
Year
Month
Year
GED test date (if not a high school graduate): ____ / ____
Unweighted
Weighted
Month
Year
Month
Year
Month
Year
Month
Year
LOCATION
CREDITS
ETS CODE
_______
_______
_______
_______
_______
_______
(City, State)
DATES OF ATTENDANCE
(Month/Year)
Estimate the total number of college-level credits you will have earned prior to your entrance into degree candidacy at Towson
University. __________ (If fewer than 30 credits, a high school transcript and SAT results are required.)
If you are attending a Maryland community college and expect to earn a degree, which type will you earn? q A.A. q A.S. q A.A.T.
Are any of these credits from a college/university outside of the U.S.? q Yes q No
If yes, you must sebmit and evaluation of these transcripts from the World Education Services (http://www.wes.org).
Have you earned a bachelors degree?
q Yes
q No
If yes, do not submit this application. Call 410-704-2113 to obtain the proper form.
Are you in good standing at all previous institutions that you attended and eligible to return?
q Yes
Has disciplinary action been initiated or taken against you at any of the institutions you attended?
q No
q Yes
q No
Answer all three questions. An affirmative response to any of these questions will not result in an automatic denial of admission or enrollment. All relevant
circumstances will be considered. The University reserves the right to request further information from the applicant to verify the information disclosed. In addition,
applicants who are admitted may be required, as a condition of participation in certain programs, to complete a Criminal History Consent Form and agree to a criminal
background check. Providing false information to any of the questions set forth below will be grounds for reject-ing an application or, if you are admitted, expulsion.
Have you been convicted of a criminal offense other than a minor traffic violation? q YES q NO
Do you currently have criminal charges pending against you other than a minor traffic violation? q YES q NO
Have you ever received a less than honorable discharge from the military service? q YES q NO
Family Information
Guardian #1: ______________________________________________________________________________________________
Last/Family Name
First/Given Name
M.I.
Number and Street/Box Number
_________________________________________________________________________________________________________
City
State
ZIP/Postal Code
Home phone: ( ______ ) ___________________________________ Email: ______________________________________________
Employer: ______________________________________________ Job title: ____________________________________________
Work phone: ( ______ ) ____________________________________
College attended: _________________________________________ Degree earned: _____________ Graduation date: _____________
Guardian #2: _______________________________________________________________________________________________
Last/Family Name
First/Given Name
M.I.
Number and Street/Box Number
_________________________________________________________________________________________________________
City
State
ZIP/Postal Code
Home phone: ( ______ ) ___________________________________ Email: ______________________________________________
Employer: ______________________________________________ Job title: ____________________________________________
Work phone: ( ______ ) ____________________________________
College attended: _________________________________________ Degree earned: _____________ Graduation date: ____________
Brothers and sisters:
Name: ______________________________ Age: _____ College Attended: _____________________________ Grad. date: _________
Name: ______________________________ Age: _____ College Attended: _____________________________ Grad. date: _________
Name: ______________________________ Age: _____ College Attended: _____________________________ Grad. date: _________
Name: ______________________________ Age: _____ College Attended: _____________________________ Grad. date: _________
E. With whom do you reside? __________________
I am financially dependent
K Yes
K No
K Yes
K No
K No
If yes, list actual years Maryland income tax returns have been filed within the past 3 years.
__________________
__________________
ii. If a Maryland tax return has not been filed within the last 12 months, state reason(s): _____________________________________________
1. Permanent address:_______________________________________________________________________________
K Yes
K No
2. Is your primary reason for living in the state of Maryland to attend the university?
Length of time at permanent address _____ years _____ months
Previous address: __________________________________________ Time at previous address: _____ years _____ months
K Yes
K No
K Yes
K No
K Yes
K No
K Yes
K No
K Yes
K No
7. Have you filed a Maryland state income tax return for the most recent year? If yes, list years you have
filed Maryland income tax returns within the past 3 years.
a. Years filed: __________________
__________________
__________________
b. If you did not file a tax return in Maryland within the last 12 months, state reason(s):
_______________________________________________________________________________________________
K Yes
K No
8. Is Maryland state income tax currently being withheld from your pay? If no, please explain.
_______________________________________________________________________________________________
K Yes
K No
9. Do you receive any public assistance from a state or local agency other than one in Maryland? If yes,
please explain. ___________________________________________________________________________________