Application for
Admission/Re-Admission
Thank you for considering ASUMH for your educational goals.
Arkansas State University – Mountain Home
1600 S College Street, Mountain Home, AR 72653
Office of Admission 870-508-6104
Fax 870-508-6287
Financial Aid 870-508-6195
COMPASS Test 870-508-6209
Campus Tours 870-508-6262
Apply online www.asumh.edu
Admission Requirements for Arkansas State University - Mountain Home
PLEASE NOTE: All students enrolling in Math or English must provide placement test scores. Also, a Tuberculin skin test is necessary for applicants who are born
outside of the United State, in any country where TB is epidemic. Contact Admissions for a list of countries identified.
FRESHMAN APPLICANT

A first-time entering student.
o
Complete the application for admission.
o
Provide an official high school transcript to ASUMH that includes the date of graduation or provide a copy of the GED
(General Education Development) test, listing the scores received.
o
If applicable, request that the registrar of each college or university attended, send ASUMH an official transcript.
o
Provide a copy of placement scores; ACT, SAT or COMPASS. Test scores used must be within 6 years.
o
Provide immunization records showing 2 MMR’s (measles, mumps & rubella vaccine).
TRANSFER APPLICANT

A student who has completed fewer than 24 semester credit hours will be admitted as a first time entering student.
(Please refer to the above FRESHMAN APPLICANT process)

A student who has completed more than 24 semester credit hours.
o
Complete the application for admission.
o
Provide an official transcript to ASUMH from each college or university attended.
o
Provide immunization records showing 2 MMR’s (measles, mumps & rubella vaccine).
VISITING/TEMPORARY APPLICANT

A student enrolled at another college or university may enroll as a temporary student.
Generally, such enrollment will apply only to summer terms.
o
Complete the application for admission.
o
Provide an official transcript or “letter of good standing” to ASUMH from the college or university the student is currently attending.
o
Provide immunization records showing 2 MMR’s (measles, mumps & rubella vaccine).
NOTE: Official transcript or placement scores may be required if visiting student is taking Math or English, or if a student needs a prerequisite course, depending on the course(s) taken.
NON-DEGREE SEEKING APPLICANT

Individuals who wish to pursue courses of special interest without submitting academic credentials may register for a maximum of
(6) per semester hours and may accumulate up to (12) semester hours of credit. Thereafter, non-degree students must comply
with college admission requirements.
o
Complete an application for admission.
o
Provide immunization records showing 2 MMR’s (measles, mumps & rubella vaccine).
ONLINE APPLICANT

Individuals pursuing classes online only.
o
Requirements are the same for online students based on student categories above.
GOLDEN AGERS APPLICANT (Register on the last day of registration and class is based on availability).

Tuition is waived for students who are 60 or older. However, the student will be responsible for fees associated with the enrolled course(s).
o
Complete an application for admission.
UNDECIDED:
(Does not qualify for financial aid; Reasons for undecided as follows):
Job Related Training
Personal Enrichment


ASSOCIATE OF ARTS (AA):
Associate of Arts
Associate of General Studies Emphasis in Teaching

Early Childhood Education (K - Grade 6)

Middle School
Associate of Science in Business
Associate of Science in Criminal Justice
Associate of General Studies
ASSOCIATE OF APPLIED SCIENCE DEGREES (AAS):
Associate of Applied Science in Criminal Justice
Associate of Applied Science in Funeral Science
Associate of Applied Science in Information Systems Technology

Graphic Design Emphasis

Networking Specialist Emphasis

Web Development Emphasis
Associate of Applied Science in Management




Accounting/Finance Emphasis
Business Development Emphasis
Hospitality Emphasis
Office Emphasis
Associate of Applied Science in Paramedic Technology
Associate of Applied Science in Registered Nursing
(Licensed Practical Nursing/Paramedic to Registered Nursing Distance)
Associate of Applied Science in Welding
Associate of Applied Science in Workforce Technology

Automotive Systems Repair

HVAC (Heating, Ventilation & Air Conditioning)

Mechatronics (Electronics, Hydraulics, Pneumatics, Robotics)
TECHNICAL CERTIFICATE PROGRAMS (TC):
Accounting/Finance
Automotive Systems Repair
General Business
Health Professions
Emphasis 1- Preparation for Traditional ASUJ RN Program
Emphasis 2- Preparation for Medical Laboratory Tech
Emphasis 3- Preparation for ASUMH LPN/PAR to RN program Radiologic
Technology, Surgery Technician or other possible health professions
Emphasis 4- Preparation for Professional Medical Coder Certification Health Tech
Emphasis 5- Preparation for students pursuing LPN program & beyond
Funeral Directing
Heating, Ventilation & Air Conditioning (HVAC)
Hospitality
Information Systems Technology
Mechatronics (Electronics, Hydraulics, Pneumatics, Robotics)
Paramedic Technology
Practical Nursing (Licensed Practical Nursing)
Welding Technology
CERTIFICATES OF PROFICIENCY PROGRAMS (CP):
A+ Computer Technician
Automotive Systems Repair
Certified Nursing Assistant (CNA)
Certified Nursing Assistant (CNA) Medication Specialist
CISCO Networking
Emergency Medical Technician (EMT)
Graphic Design
Heating, Ventilation & Air Conditioning (HVAC)
Mechatronics (Electronics, Hydraulics, Pneumatics, Robotics)
Office Specialist
Phlebotomy
Professional Medical Coder
Web Development
Welding Technology
What semester will you be starting?
Fall
Spring
Summer 1
Summer 2
Application for Admission/Re-Admission
Aug-Dec
Jan-May
June
July
20 ____
20 ____
20 ____
20 ____
PERSONAL INFORMATION
Social Security Number
Last Name
________________________________________________
All previous last names used
First Name
Middle
________________________
Date of Birth (mmddyy)
__________________________________________________________________
Mailing Address
Apartment #
Suffix (Jr., Sr., etc)
Male
Female
Email: _____________________________________________________
____________________________________________________________________________________________________________________________________
City
State
Zip Code
County
Country
____________________________________
Cell Phone
___________________________________
Alternate Phone
Allow text messages? (ASUMH Alert System)
Yes
No
EMERGENCY CONTACT INFORMATION
_____________________________________________________________________________________________________________________________________
First Name
Last Name
Relationship
Phone Number
CITIZENSHIP
US Citizen
Non-resident (undocumented)
Resident Alien (green card)
Have you been a resident of Arkansas for at least six (6) months?
Yes
No
If no, please indicate previous state and date moved to Arkansas.
International (F1, J1, etc)
Choose all that apply below. (Required for federal reporting by Civil Rights Act of 1964)
White
Pacific Islander/Native Hawaiian
Black/African American
American Indian/Alaskan Native
Hispanic/Latino
Asian
Other (specify) ________________
(Please notify the Admission Office when residency status changes to in-state!)
____________________________________________________
State
(mmddyy)
ACADEMIC INFORMATION High School or GED information (whichever applies to you)
__________________________________________________________________________________________________________________________
List High School Attended (please list high school even if you did not graduate)
City/State
Mo/Year of Graduation (mmyy)
GED Completion Date (mmyy) ________________________________________________ GED Completion State __________________________________________
Please list ALL colleges, universities or other post-secondary institutions attended (not including ASUMH)
Name of School
City
ENROLLMENT STATUS
EDUCATIONAL OBJECTIVE
First-Time Entering College
Transfer Student
Visiting/Temporary Student
Re-Admission
Concurrent (high school/college dual enrollment)
G Golden Ager (age 60 or older)
(See Degree List on previous page)
(enter choice here)
Yes
No
Dates of
Attendance
Semester
Hours
Degrees Earned
(if any)
REASON FOR ENROLLMENT
Complete Associate Level Program at ASUMH
Complete a Technical Certificate at ASUMH
Complete a Certificate of Proficiency at ASUMH
Non Degree Seeking
INTENDED MAJOR AT ASUMH __________________________________
Will you be taking online classes only?
ST
Complete Course Work at ASUMH
Complete Course Work at Another Institution
Obtain or Improve Job Skills
Personal Enrichment
Complete Course Work as Concurrent or
Dual Enrollment
CP TC or 2yr
(Certificate of Proficiency, Technical Certificate, AA or AAS )
JUDICIAL INFORMATION (failure to answer these questions will delay the processing of the application for admission)


Have you ever been convicted of a felony or are there any felony criminal charges now pending against you? _____Yes _____ No
Are you a convicted sex offender or required to register as a sex offender?
_____ Yes _____ No
The existence of a conviction does not necessarily mean that a student will be denied admission to ASUMH. However, failure to provide complete, accurate
and truthful information will be grounds to deny or withdraw the admission, or to dismiss student after enrollment.
STATE OF ARKANSAS STATEMENT OF SELECTIVE SERVICE STATUS – REQUIRED
To be eligible for enrollment in a public institution of higher education in the State of Arkansas, I understand that I must register or be exempt
from registration, with the Selective Service System in accordance with the Military Selective Service Act, 50 U.S.C.
Appx 451 et seq., as specified in Act 228 of the 1997 Acts of the Arkansas General Assembly.
I therefore swear or affirm under penalty of perjury that I have registered with the Selective Service System.
or
I am exempt from such registration because of the following provision(s) of the Military Selective Service Act or
Act 228 of the 1997 Acts of the Arkansas General Assembly:
I am a female
I am a current member of the armed forces on active duty
I am under 18 years of age
I am 26 years of age or over
I am an exempted resident alien
Other, specify _____________________________________
Signature __________________________________________________
Are you an active member/veteran of the United States Armed Forces?
How did you find out about ASU – Mountain Home? (Choose below)
College Rep Visit
Friends
Newspaper
Career/College Days
Facebook
Web Search
High School Counselor
Radio
Other _____________
Yes
Date ___________________________________
No
Do any of these apply to you? (Choose below)
Displaced Homemaker
Limited English Proficiency
Single Parent
Disabled
Yes
Yes
Yes
Yes
No
No
No
No
(as defined in the Americans with Disabilities Act of 1990)
FERPA (Family Educational Rights and Privacy Act) – OPTIONAL
Arkansas State University – Mountain Home with appropriate discretion, based on FERPA, may disclose students’ directory information. Details regarding this
information may be found in the catalog under FERPA of 1974. As a student of Arkansas State University – Mountain Home you have the following choices:
Allow your directory information to be disclosed with appropriate discretion
Limited Non-Disclosure (allow information needed for blackboard, emails and inclusion of name in the commencement program and honors list)
Complete Non-Disclosure (choosing this option will prevent access to gmail, blackboard, etc)
Signature of Applicant _______________________________________
Date _________________________
I affirm that all information supplied is complete and accurate. Any misrepresentation of facts could be cause for refusal of admission,
cancellation of admission, or suspension from the university.
STATEMENT OF ASSURANCE: ASUMH assures that no person shall, on the basis of race, color, national origin, age, sex or disability, be excluded from participation in or be
subjected to discrimination under any program activity. ASUMH, in making decisions regarding student admissions and other functions and
operations, adheres to a policy of non-discrimination.
Arkansas State University – Mountain Home
1600 S College Street
Mountain Home, AR 72653
870-508-6104
870-508-6287 (fax)
Apply online www.asumh.edu