For Office Use Only Application for Undergraduate Admission Please complete this application and return it to the Office of Admission at Shawnee State University, 940 Second Street, Portsmouth, Ohio 45662-4344. You should arrange to have your high school or GED transcript and results of the SAT or ACT sent to the Office of Admission. Applicants age 21 or over are exempt from providing SAT or ACT scores. If you have attended another college or university, the registrar from that institution must forward an official college transcript to the Office of Admission at Shawnee State University. All questions must be answered. If not applicable, answer N/A. Social Security Number: ____________________________________________________ Name: ___________________________________________________________________________________________________________________________ Last First Permanent or Parent’s Address: Local Address: M.I. Maiden Name Date of Birth: ____________________________________ Month/Day/Year ______________________________________________________________________________________________________________________________________________________________________________ Street City State Zip _________________________________________________________________________________________________________________________________________________________________________________ (If different from above) Street City ( ) Home Phone: ________________________________________ State ( ) Cell Phone: ________________________________________ Zip E-mail Address: ______________________________________________ I would like to receive text messages from Shawnee State University Yes No High School Attended: ______________________________________________________________________________________________________ Year of Graduation/GED: ___________________ High School Location: _____________________________________________________________________________________________________________________________________________________________________ City State Citizenship: Zip Housing/Living Arrangements: United States U.S. Permanent Resident (Reg. # _________________________________________________) Other Country _________________________________________________ Commuter (drive from home) On-Campus Housing Resident Status for Past 12 Months: Resident of Ohio Resident of Kentucky: _________________________________________________ County Resident of another state Dates you have lived in Ohio (you must choose one): Birth to present From (month/year) ___________________________ To (month/year) ___________________________ Never Financially dependent students Name the person upon whom you are dependent for more than half of your financial support: _________________________________________________________________________________________________________________________________________________________________________________________________ First Name M.I. Last Name _________________________________________________________________________________________________________________________________________________________________ Residence Address: Number & Street (required) City State/County Zip Phone (area code first) Dates the person listed above has lived in Ohio (you must choose one): Birth to present Reset Page 1 From (month/year) __________________________ To (month/year) __________________________ Never Form # – A:052888 revised 04/25/14 *Have you ever been convicted of a felony in any state? Yes No If yes, year ________ *Have you ever been convicted of any crime where you were adjudged a sex offender in any state? Yes No If yes, year ________ Please see the additional information below regarding these questions as set forth in this application. List all colleges/universities attended previously: _____________________________________________________________________________ City _______________________________________ State ____________ Dates Attended _____________________________ _____________________________________________________________________________ City _______________________________________ State ____________ Dates Attended _____________________________ Are you a veteran/reservist/or national guard or a dependent of? Yes No Student Intent in Enrolling: 08 — To obtain a bachelor’s degree. 02 — To obtain an associate’s degree for the job market. 03 — To obtain an associate’s degree, then transfer to another 4-year college or university. 01 — To obtain a certificate. 04 — To transfer to another 4-year college or university before completing a degree/certificate. 05 — To train for a new career by taking only selected courses. 06 — To upgrade skills for current job by taking only selected courses. 07 — To obtain knowledge for personal interest. Do you plan to earn a degree or certificate from Shawnee State University? Yes No Please indicate your planned major code. If you are uncertain, please select “UNDC” (undecided) Voluntary Disclosure: The information requested in the shaded area is used to report student and applicant demographic information to state and federal agencies. Your completion of this area is completely voluntary. This information will not be used for discriminatory purposes.* Gender: Male Female Hispanic: Yes No (1) Nonresident Alien (2) Race and Ethnicity unknown (3) Hispanics of any race Non-Hispanics only: (4) American Indian or Alaska Native (5) Asian (6) Black or African American (7) Native Hawaiian or other Pacific Islander (8) White (9) Two or more races Have either of your parents received a 4-year college degree? Yes No Race/Ethnic: (Check only one) * Shawnee State University does not discriminate in admission, access, or treatment in programs and activities or employment policies or practices on the basis of race, creed, sex, color, national or ethnic origin, religion, marital status, age, sexual orientation, or disability. Inquiries regarding Title IX may be directed to the Title IX coordinator, who is also the coordinator of special needs services, at 740.351.3276. Click To View Major Codes ____ ____ ____ ____ ____ ____ ____ ____ Term you plan to attend: 20 _ _ Spring Semester Are you a dependent of a Shawnee State University employee? Yes No Has anyone in your family attended Shawnee State University? Yes Name __________________________________________________________________ No Address ________________________________________________________________ Relationship to you _____________________________________________ Summer Semester Fall Semester I certify that the statements included in this application are accurate and true to the best of my knowledge. Any falsification of information may result in disciplinary action, including dismissal. Signature Date APPLICATION CHECKLIST I have asked my counselor to send my transcript and test scores to Shawnee State University. I have requested official transcripts from all colleges/universities previously attended. I have signed and dated my application. * If you fail to answer or provide an incorrect answer to the questions regarding conviction of a felony and/or sex offender crime, you may be denied admission to the University or, if already admitted, may be expelled from the University. Answering the question(s) affirmatively may result in the University requiring additional information from you prior to admission. Answering in the affirmative will not necessarily bar admission to the University but may result in certain restrictions. Reset Page 2 High School Transcript Request Form To the applicant: Please fill in your name and social security number and give this form to your guidance counselor. Social Security Number: Student Name: This applicant ranks Last First in a class of Middle Former Name and has a grade point average of on a This rank is weighted unweighted. This GPA is weighted unweighted. Name (please print) Signature Position High School Name Please attach an official copy of this student’s transcript and test scores and mail to: Office of Admission, Shawnee State University, 940 Second Street, Portsmouth, OH 45662. Reset Page 3 Reset All Forms scale. SHAWNEE STATE UNIVERSITY MAJOR CODES Click to Continue Form MAJOR CODE BUSINESS MAJOR CODE FINE, DIGITAL, & PERFORMING ARTS ACCT ARTSARTS LEGL Accounting Technology (AAB) Business Administration, Accounting (BS) Business Administration, General (BS) Business Administration, Health Management (BS) Business Administration, Info. Systems Management (BS) Business Administration, Legal Assisting (BS) Business Administration, Marketing (BS) Business Management Technology (AAB) Information Technology Management (AAB) Legal Assisting Technology (AAB) MAJOR CODE EDUCATION ARTSMUSI BFARCERM BFARDRAW BFARGSDA BFARMTHR BFARPTNG BFARPHOT BFARSTAR BFARVIAN BFARVIDD BFARVIMT Arts/Humanities, Art (AA) Arts/Humanities, Music (AA) Fine Arts, Ceramics (BFA) Fine Arts, Drawing (BFA) Fine Arts, Game and Simulation Development Arts (BFA) Fine Arts, Musical Theater (BFA) Fine Arts, Painting (BFA) Fine Arts, Photography (BFA) Fine Arts, Studio Arts (BFA) Fine Arts, Visual Arts, 3D Animation (BFA) Fine Arts, Visual Arts, Design (BFA) Fine Arts, Visual Arts, Interactive Media (BFA) DFST MAJOR CODE HEALTH SCIENCES ATTR DTHY EMTP MLTC ADNR BSNR Athletic Training (BS) Dental Hygiene (AAS) Emergency Medical Technology (AAS) Medical Laboratory Technology (AAS) Nursing (AAS) Nursing (BS) Occupational Therapy Assistant (AAS) Physical Therapist Assistant (AAS) Radiologic Technology (AAS) Respiratory Therapy (AAS) Sports Studies, Exercise Science (BS) Sports Studies, Sport Management (BS) SSCIADSS Deaf Studies (Certificate) Early Childhood Development w/Pre-K Licensure (AAS) Early Childhood Education (Gr. PreK-3) (BSE) Early Childhood Intervention Specialist (Gr. PreK-3) (BSE) Eng./Hum., Integ. Lang. Arts, Adol-Yng. Adlt. (Gr. 7-12) (BA) Fine Arts, Multiage Visual Arts (Gr. K-12) (BFA) Intervention Specialist (Gr. K-12), (BSE) Mathematics, Integ. Math., Adol-Yng. Adlt. (Gr. 7-12) (BS) Middle Childhood, Lang. Arts/Mathematics (Gr. 4-9) (BSE) Middle Childhood, Lang. Arts/Science (Gr. 4-9) (BSE) Middle Childhood, Lang. Arts/Social Studies (Gr. 4-9) (BSE) Middle Childhood, Mathematics/Sciences (Gr. 4-9) (BSE) Middle Childhood, Mathematics/Social Studies (Gr. 4-9) (BSE) Middle Childhood, Science/Social Studies (Gr. 4-9) (BSE) Natural Science, Earth Science, Adol-Yng. Adlt. (Gr. 7-12) (BS) Nat. Sci., Inter. Science, Biology, Adol-Yng. Adlt. (Gr. 7-12) (BS) Nat. Sci., Inter. Science, Chem., Adol-Yng. Adlt. (Gr. 7-12) (BS) Nat. Sci., Inter. Science, Earth, Adol-Yng. Adlt. (Gr. 7-12) (BS) Nat. Sci., Inter. Science, Phys., Adol-Yng. Adlt. (Gr. 7-12) (BS) Nat. Sci., Life Science, Adol-Yng. Adlt. (Gr. 7-12) (BS) Nat. Sci., Physical Science, Adol-Yng. Adlt. (Gr. 7-12) (BS) Social Sciences, Integ. Soc. Stu., Adol-Yng. Adlt. (Gr. 7-12) (BA) MAJOR CODE ENGINEERING TECHNOLOGIES ETCA ETTSURAN Computer Aided Drafting and Design (AAS) Computer Engineering Technology (BS) Digital Simulation and Gaming (BS) Electromechanical Engineering Technology (AAS) Environmental Engineering (BS) Plastics Engineering Technology (AAS) Plastics Engineering Technology (BS) Pre-Engineering (AS) Technical Study, Building Maintenance Technology (ATS) Technical Study, Carpentry Craft Technology (ATS) Technical Study, Computer Technology (ATS) Technical Study, Construction Technology (ATS) Technical Study, Electrical Craft Technology (ATS) Technical Study, Environmental Field Technology (ATS) Technical Study, Industrial Maintenance Technology (ATS) Technical Study, Pipefitting Craft Technology (ATS) Technical Study, Uranium Enrichment Technology (ATS) MAJOR CODE ENGLISH & HUMANITIES ARTSCOMM Arts/Humanities, Communications (AA) Arts/Humanities, English (AA) Arts/Humanities, General (AA) English/Humanities, Communications (BA) English/Humanities, Culture and Media Studies (BA) English/Humanities, General (BA) Philosophy and Religion (BA) BADMACCT BADMGEN1 BADMHMGT BADMISM BADMLEGL BADMBMKT BMGT ITM ECD EDEC ECIS ENGLADLA BFARMAVA EDIS MATHADMA EDMCMLM EDMCMLSC EDMCMLSS EDMCMMS EDMCMMSS EDMCMSCS NTSCADES NTSCADSB NTSCADSC NTSCADSE NTSCADSP NTSCADLS NTSCADPS ETCO ETGG ETEM ETEV ETPA ETPL ETPE ETTSBLDM ETTSCARP ETTSCOMP ETTSCSTR ETTSELEC ETTSENFT ETTSINDM ETTSPIPE ARTSENGL ARTSGEN5 ENGLCOM2 ENGLMEDI ENGLGEN2 PHRL OTAT PTAT RDLT RPTT SPSTFITN SPSTSPMG MAJOR CODE MATHGEN3 MATA MATHEMATICAL SCIENCES MAJOR CODE NATURAL SCIENCES BIOLBIOM BIOLBIOE BIOLBIOB CHEM NTSCBIOL NTSCCHEM NTSCGEOL NTSCPHYS NSCINSSC Biology, Biomedical (BS) Biology, Ecology/Environmental (BS) Biology, General (BS) Chemistry (BS) Natural Science, Biology (BS) Natural Science, Chemistry (BS) Natural Science, Geology (BS) Natural Science, Physics (BS) Sciences (AS) MAJOR CODE SOCIAL SCIENCES HIST INRL PSYC SSAS SSCIGEN4 SSCILASS SOCI History (BA) International Relations (BA) Psychology (BA) Social Science (AA) Social Sciences, General (BA) Social Sciences, Legal Assisting 2+2 (BA) Sociology (BA) MAJOR CODE OTHERS AIST BIST NODG UNDCBUSN UNDCEDUC UNDCENGT UNDCHLTH UNDCLBRA UNDCMASC UNDCSOSC Individualized Studies (AA) Individualized Studies (BA) Non-Degree Undecided - Business Undecided - Education Undecided - STEM - Engineering Technology Undecided - Health Sciences Undecided - Liberal Arts Undecided - STEM - Mathematics/Science Undecided - Social Sciences Mathematical Sciences (BS) Mathematics (AS) Click to Continue Form