Austin Bluffs Parkway,
P.O. Box 7150
Colorado Springs, Colorado 80933-7150
Phone: (719) 262-3383

TYPE OR PRINT ALL INFORMATION. Answer all questions completely. Attach additional sheets if necessary.

Full Legal Name. (Do not use nickname)

Last Name________________________________________

First Name________________________________________

Middle Name______________________________________

Other Names which may appear on your academic records
_________________________________________________

Social Security Number: _ _ _ - _ _ - _ _ _ _

Former CU Student #____________________________________

Male Female

Mailing Address

Number and Street or P.O. Box _____________________________________________________________

City_______________________________________

State______________________________________

Zip________________________________________

Number and Street or P.O. Box______________________________________

City, State, and Zip Code____________________________________

Work Area Code/Phone (_ _ _ )________________

Nation of Citizenship____________________
If not a U.S. citizen, what type of visa do you have?___________________Please attach photo copy

The following Selective Service question must be answered to comply with Colorado law:
If you are a male born after December 31, 1959, are you registered with the Selective Service?
Yes No

Under requirements of the U.S. Dept. of Education, ethnic information must be collected and reported by collegiate institutions. This information is not used in the admissions decision.

Please circle one

Hispanic
American Indian or Alaskan Native
Asian or Pacific Islander
Black/African America, not of Hispanic origin
Caucasian/White, not of Hispanic origin

Letters, Arts and Sciences
Business
Engineering
Nursing
Unclassified (Non Degree)
Other (Former CU students only)

Proposed Major________________________
Toward which degree will you be working?_____________________________

List last high school and all colleges attended. Failure to provide complete information may result in delay in admission, loss or transfer credit, and/or dismissal. Include correspondence and extension courses. Transcripts, when provided, must come from each issuing institution directly to the University of Colorado.

High School

Name_______________________________________________

City________________________________________________

State________________

Zip Code_____________

Highest Grade Completed (1 through 12)_____________

Date of High School graduation_________/_________

Indicate when you took or plan to take college entrance exam:
ACT (mo./yr.)_________/_________
SAT (mo./yr.)_________/_________

If not a high school graduate, have you earned a State GED Certificate?
Yes No (If "yes," photo copy must be attached)

List All colleges and universities attended, including University of Colorado campuses.
Attach additional sheets if necessary.

Name of Institutions (List first to last)	City, State, Zip	Dates	Hours Completed	Degree Earned
.	.	.	.	.
.	.	.	.	.
.	.	.	.	.
.	.	.	.	.

I am elgible to return to all collegiate institutions previously attended.
Yes No (If "no," please attach explanation.)

I certify that I have a "C" or better cumulative average for all college work attempted.
Yes No

Do you plan to apply for financial aid? Yes No
(Unclassified Students are not eligible for financial aid.)

 

Emergency Information

Parent, Relative or Friend Last Name___________________________ First Name___________________________ Relationship_____________________ Area Code/Phone: (_ _ _) _______________	City______________________ State_____________ Zip_______________
Address (Number and Street) ____________________________________________________________________

 

Work Experience

Type of Work	Employer	City, State	Dates	Hours/Week
.	.	.	.	.
.	.	.	.	.

 

Tuition Classification

Complete This Section If You Are Claiming Colorado In-State Tuition Classification

Failure to compete each question fully will result in your being classified as a nonresident
The information you provide will be kept confidential and is used soley to determine residency

	You	Your Parent (If you are under 23)
Dates of continuous physical presence in Colorado (mo/yr)	____/____ to ____/____	____/____ to ____/____
Date Colorado Driver's License was issued (mo/yr)	____________________	____________________
List exact years of Colorado Motor Vehicle registration	____________________	____________________
Date of Colorado Voter Registration (month/year)	____________________	____________________
Date of purchase of any Colorado residential property (month/year)	____________________	____________________
Dates of employment in Colorado (month/year)	____/____ to ____/____	____/____ to ____/____
Dates of military service, if applicable (month/year)	____/____ to ____/____	____/____ to ____/____
List all years Colorado income taxes have been filed	____________________	____________________
*Date of marriage (month/year). Answer this question if you will be under 22 by initial enrollment date List all years Colorado income taxes have been filed.	____________________
If your parents are separated or divorced, which one lives in Colorado?	____________________
Dates of extended absences from Colorado (month/year)

gone for more than one month at a time

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Educational Status

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____/____ to ____/____	____/____ to ____/____
Reason for absence_________________________________________________________
*Response to This question is voluntary, will not affect the admission process, and is used only to determine residency status.
Students who claim a change in tuition classification must petition the Office of Admissions and Records prior to registration.

I am not presently enrolled in high school or college nor do I plan to enroll at another school prior to the term for which I am applying at the University of Colorado.

I am presently enrolled in high school or college and my last term there will be: (circle one)

Fall

Winter

Spring

Summer

Applicant: Complete this section if currently enrolled in high school or college. List all course work not appearing on current transcripts but to be completed before intended enrollment. Order final transcripts to be sent when all work is completed.

Name of high school or college	Course Number & Department	Complete Course Title	Credits	Term & Year
__________________	__________________	_____________________	______	_______________
__________________	__________________	_____________________	______	_______________
__________________	__________________	_____________________	______	_______________
__________________	__________________	_____________________	______	_______________
__________________	__________________	_____________________	______	_______________

Circle appropriate term system:

Semester

Quarter

Trimester

Other______________________

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Signature

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All APPLICANTS IMPORTANT:
YOU MUST ANSWER THE QUESTION BELOW AND SIGN THE APPLICATION

1. Are you presently charged with or have you ever been convicted of a felony.
   Yes No

2. Are you applying through the CU Opportunity Program (CUOP), a program for ethnic minority students and students from educationally/financially disadvantaged backgrounds?
   Yes No

   I herby certify that to the best of my knowledge the information furnished in this application is true and complete. I understand that if found to be otherwise, it is sufficient cause for rejection or dismissal. I understand that if admitted as an unclassified student a maximum of 12 hours may be applied to an undergraduate degree or 9 hours MAY be applied to a graduate degree.

3. Applicant's Signature ________________________________ Date__________

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HIGH SCHOOL OFFICIAL please fill in: (freshmen applicants only who are currently enrolled in high school)

gpa ___________________ (4.0 scale)

Rank in class __________ / __________ For how many semesters? __________ OR

check here

 By policy of this high school, students are never ranked in class.

_______________________________________	_______________________________________
Signature of high school official	Title

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The University of Colorado is an Equal Opportunity Educational Institution