ADMISSIONS APPLICATION
Admissions Office
DSU Admissions, 225 S. University Ave. St George, UT 84770 | Phone: (435) 652–7777, Fax: (435) 879–4060, [email protected]
ADMISSIONS INSTRUCTIONS
Priority Deadline: August 15th for Fall Semester, January 2nd for Spring Semester.
Freshman
Transfer
Returning
Non-Degree
•
$35 Application Fee
(non‑refundable)
•
$35 Application Fee
(non‑refundable)
•
$10 Application Fee
(non‑refundable)
•
•
High School Transcript or GED
•
Test Scores (ACT, SAT, or
Accuplacer.)
Submit official transcripts
from all previous colleges/
universities
•
•
•
If less than 24 credits earned,
also submit high school
transcript & test scores (ACT,
SAT, or Accuplacer.)
Submit official transcripts
from all previous colleges/
universities (if you attended
another college since last
attended DSU)
Student Information
Legal Name: FRESHMAN STUDENT q
Last
TRANSFER STUDENT q
$35 Application Fee
(non‑refundable)
(Not eligible for financial
aid or scholarships)
RETURNING STUDENT q
First
NON-DEGREE STUDENT q
Middle Initial
Preferred 1st Name, if any
Former Last Name(s): Date of Birth: Social Security #: mm/dd/yyyy
Home Phone Number: Cell Phone Number: e.g. (435) 111–1143
Permanent Mailing Address: Street
Local Address (if different from above): Street
e.g. (435) 111–1143
City
StateZip
City
StateZip
Email address: Emergency Contact (Parent/Legal Guardian/Spouse): Address: (Emergency Contact Info)
Street
Are you a U.S. Citizen?: Yes: q
No: q
City
Ethnicity:
Male:
Hispanic/Latino:
State
Last Name
Yes:
q
Relationship
Phone #: Zip
Resident Alien: q
(provide green card copy)
Are you a Military Service member or a Veteran?: Gender:
First Name
Deferred Action: q
(Provide Employment Authorization Card)
No: q
qFemale: q
qNot Hispanic/Latino: q
RECEIVED
STUDENT ID #:
Race (check all that apply):
African American/Black:
q
Alaskan Native: q American Indian: q
q Caucasian/White: q Pacific islander/Native Hawaiian: q
Other: q APPLICATION #:
Asian:
Did either of your parents complete a bachelor’s degree: Yes: q No: q
DATE PAID:
Continued On Back…
OFFICE USE ONLY
Admission Status
Desired degree Type? Bachelor’s Degree: q Applying for:
Fall: q Spring: q
Associate’s Degree: q
Non-degree seeking: q
Summer: q year
Planned Course of Study (major): What are your intentions while attending DSU?: Earn a Bachelor’s degree from DSU:
Taking courses with intention to transfer:
q
Earn a Associate’s degree from DSU:
q
Personal Interest:
q
q
Residency Status
Driver License or Learner Permit?: Yes: qNo: q Issuing State: Date of Issue:
/
How long?:
State of legal residence: Please list where you have lived and what you have been doing for the past two years (e.g. employment, school, etc.):
From (month/year)
To (month/year)
Employer or Activity
City
State
Educational Background
High School: Location:
Graduation Date ( or anticipated): Have you taken the GED?:
Requirement
Requirementmonth/year
citystate
Yes:
q No: q Date: month/year
Colleges or Universities Attended (List ALL schools previously attended):
Name of Institution
Location
Dates Attended (from/to)
Credits/Degree
Applicant Signature
I certify that the information provided is true and accurate to the best of my knowledge, and that I will abide by the academic standards of the
University. I further declare that upon enrollment, I will pay the full tuition and fees due by the established deadline or pay an additional $50 late
fee. If I fail to pay tuition and my account is forwarded to a collection agency, I will also pay the collection fees (not to exceed 50% of the principal)
along with any relevant court/attorney fees. I understand that all monies owed me by DSU or from Title IV funds can be used to pay any delinquent
tuition and fees, and that outstanding balances can be considered loans (under I.R.C. 221) and are exempt from any federal bankruptcy proceedings
(11 U.S.C. 523 (a)(8). Any misrepresentation or non-disclosure in completing this form may subject me to disciplinary action and/or dismissal from the
University.
Signature: Date: Dixie State University consumer information can be found on our web page at http://right2know.dixie.edu. This site contains information regarding
our general student body graduation and transfer rates, crime statistics and campus security tips, alcohol and drug prevention information and the
Family Educational Rights and Privacy Act (FERPA).