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of Portland. Please use this checklist to make sure you receive a timely admission decision. A. PRINT THIS PACKET... ...and save it for your records. To print, hit Ctrl/Cmd+p; to save, hit Ctrl/Cmd+s. B. WRITE youR ESSAy... ...if youre an education or nursing major and did not submit your essay online, please send it to the address below. C. REQuEST ALL oF youR oFFICIAL CoLLEGE TRANSCRIPT(S)... In addition, if youve taken fewer than 30 semester/45 quarter hours, then please send us your official test scores and high school transcript(s). Should you need them, our code for the SAT is 4847, and our code for the ACT is 3500. We look forward to reading your application and getting to know you better. Jason McDonald Transfer Admissions, MSC 180 University of Portland 5000 N. Willamette Blvd. Portland, OR 97203-5798 P.S. Come visit if you havent alreadyor even if you have! To schedule a visit or ask any questions about UP, please feel free to call us at (888) 627-5601.
Office of Admissions
Personal Information
Please provide your legal name below. First Name Middle Name Last Name Former Last Name(s), if any Preferred First Name Social Security Number
(optional)
Cell Phone
International Number?
I am applying for the term beginning: Fall 2012 *All nursing major applications are for the Spring 2013 semester.
Address Information
Address Street Address Line 2 City State/Province Postal Code Country Mesa Arizona 85208 United States 845 South Sabrina
Mailing Address
(if different from your permanent address) Address Street Address Line 2 City State/Province
Citizenship
Are you a First language, if other than English U.S. citizen
Ethnicity
Are you Hispanic or Latino? Please check all that apply. No [ ] [ ] [ ] [ ] [X] American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Parent Education
Please indicate if one or both of your parents attended college. Yes
Family Member #1
Relationship First Name Last Name Telephone This person's address and mine are Mother Cori Fabian 480-688-4379 Same
Occupation
Name of Business or Organization Position Bridges E.C.E. Executive Director
Tempe AZ
Country
US
Degree(s)
No
Family Member #2
Relationship First Name Last Name Telephone This person's address and mine are Father Howard Fabian 480-254-3909 Same
Occupation
Name of Business or Organization Position Self Employed Self
Central Arizona College 273 Old West Highway Apache Junction AZ 85219 United States
Degree(s)
NONE
No
Family Information
Please list any family members that have attended University of Portland.
First Name
Please list the names and ages of all other immediate family members and colleges or universities that they have attended.
First Name Last Name Relationship Age College Attended and/or degree earned Alex Hardy Foster/Adopted Brother 20 Mesa Community College
First Name Last Name Relationship Age College Attended and/or degree earned
Declaration of Major
Have you previously applied to the University of Portland? Please select an intended major: Planned Career Goal Attention Nursing Applicants *The deadline to apply for the Transfer Nursing Program is January 15 at midnight PST. We will not accept any nursing applications after this date and time. Transfer eligibility and requirements can be viewed here. No Engineering: Electrical and Computer Software Engineering, Music Production, Professor
College(s) Attended
Cumulatively, have you completed fewer than 30 semester hours or 45 quarter hours at another college or university? Have you earned or do you plan on earning a bachelor's degree prior to attending University of Portland? No
No
Please list all colleges or universities you have attended or are currently attending. We are unable to process your application unless we have individual official transcripts from every college or university you have attended. Name Mesa Community College
Address City State/Province Postal Code Country Dates Attended From To Degree
Current Schedule
Please list all courses you are taking during 2011-2012.
Course Name
Course Name
Course Name
Course Name
Course Name
Name of High School Address City State/Province Postal Code Country Telephone Counselor Name Date of Graduation Your school is List any prior high schools attended.
Skyline High School 845 S Crismon Rd Mesa AZ 85208-2564 US 480-472-9400 Leach 05/2009 Public
Test Information
Official SAT or ACT scores are required only if you have completed fewer than 30 semester hours or 45 quarter hours from a college or university at the time you apply. If you have completed more than 30 semester hours or 45 quarter hours, please disregard this test information section.
ACT
Have you taken the ACT exam?
SAT
Have you taken the SAT exam? Yes
Date on which you have taken this test. Critical Reading Math Score
Employment
Please list any job you have held during the past four years.
Employer Specific Nature of Work Approximate Dates From To Approximate Hours/Week 08/2006 10/2011 25 Barros Pizza Delivery Driver
01/2010 12/2010 20
Please identify people, events, or things that influenced your decision to apply to the University.
Teacher/counselor UP student Relative High school visit UP admissions representative UP alumni Brochures College fair UP faculty or staff member Friend Visit to campus UP website Catholic affiliation Academic programs Other
Explain other.
Please read and check the boxes before submitting your application.
Have you ever been dismissed, suspended Yes from, or on disciplinary probation from a secondary school or college? Please explain your dismissal or suspension in the space below. Really quite petty actually, and I'm not sure if its even applicable- but I was sent home for one day during my Junior year of high school for cursing under my breath in class. Have you ever been arrested or convicted of any violation? No
Final Steps
If you feel that your academic record does not accurately reflect your ability, if there is additional information that may be important to the Admissions Committee in its evaluation of your application, or if you have been out of school for more than six months, briefly explain.
[X] I understand that the University of Portland must have an individual official transcript from every university or college I have attended. (If you have questions about meeting this requirement, please call our Office of Admissions at 1.888.627.5601.) [X] If I attend University of Portland, I grant the University, or any third parties selected by the University, permission to use or publish, in any medium, my photograph, likeness, or image for any purpose chosen by University of Portland. [X] I declare that all the information contained in my application is correct, complete, and honestly presented. Shayne, this is your last chance to review your application. After you've checked everything and are ready to send the final