2012-13
2014
– 15 application for transfer admission — evening degree program
also available online at https://www.applyweb.com/apply/uwed/
Where you see the
icon, find the instructions for that question. You are accountable for providing complete and
accurate information. Omissions or inaccurate information may result in the denial of admission.
Classification
C-1.
Classification: Check one box only
NOTE:
 Transfer: Evening Degree only; see separate application for Day Programs.
If you are seeking non-degree admission for summer quarter, do not complete this form. Apply directly at www.summer.washington.edu/summer.
Quarter
Q-1.
(C)
(Q)
Quarter. For which quarter and year are you applying? Check one box only
 SUMMER 2014
2012
(begins June 2012)
2014)
Deadline: May 15, 2012
2014
Major
AUTUMN 2014
 AUTUMN
2012
(begins September 2012)
2014)
Deadline: July 15,
31, 2012
2014
 WINTER 2015
2013
(begins January 2013)
2015)
Deadline: Oct. 31, 2012
2014
(MJ)
MJ-1. Intended major (check one only)
MJ-2. Alternate Major. What is your second-choice major? Optional
 Communication: major code COM
COM EE
Communication: major
major code
code COM E
 Communication:
 English ENGL
ENGL EE
English ENGL E
 English
Health Informatics
 Humanities
HUM E & Health Information Management HIHIM E
Health Informatics
 Humanities
HUM E & Health Information Management HIHIM E
Social Sciences
SOCS
 Health
Informatics
& EHealth Information Management HIHIM E
Social Sciences
SOCS
E
 Health
Informatics
& Health
Information Management HIHIM E
 Social Sciences SOCS E
 Social Sciences SOCS E
Previous Attendance
PA-1.
 SPRING 2015
2013
(begins March 2013)
2015)
Deadline: Jan. 31, 2013
2015
(PA)
Have you ever applied for admission to the UW?  No  Yes: _______________________________ Quarter/Year
PA-2a. Have you ever attended the UW?  No  Yes
PA-2b. If yes, indicate the campus / type(s) of enrollment (check all that apply):
 Bothell
 Day
 Distance/Online Learning
PA-2c. Date of First Attendance
Personal Information
 ELP (ESL)
 Evening
mm/yyyy
 Extension
 UW College in the High School
(PI)
 Male  Female
PI-2.
Social Security Number
PI-4.
Legal Name: To avoid confusion, use your full legal name whenever you contact Admissions.
PI-5.
 Tacoma
PA-2d. UW Student Number (7 digits) ______________________________
PI-1.
Last (Family) Name
 Summer
PI-3. Date of Birth
First (Given) Name
mm
dd
19
Middle
Jr., etc.
Other Name(s): If your name has changed, indicate your former full name(s).
Last (Family) Name
First (Given) Name
Middle
Jr., etc.
Last (Family) Name
First (Given) Name
Middle
Jr., etc.
UW Seattle Transfer Application A1
OFFICE USE ONLY
OFFICE USE ONLY
Address
(AD)
AD-1. Mailing
Address (AD)
Address
AD-1. Mailing Address
Number and Street
Apt.
Number and Street
City
State (Province/Territory + Country if not U.S.)
Apt.
AD-2. Permanent
Address
City
 Same as Mailing Address in AD-1

Different:
complete+the
address
information
below
State
(Province/Territory
Country
if not
U.S.)
AD-2. Permanent Address
 Same as Mailing Address in AD-1
 Different: complete the address information below
Number and Street
Zip+4 (or Postal Code if not U.S.)
Zip+4 (or Postal Code if not U.S.)
Apt.
Number and Street
City
State (Province/Territory + Country if not U.S.)
AD-3a. Home
City telephone (U.S. phone numbers only)
Apt.
State (Province/Territory + Country if not U.S.)
Zip+4 (or Postal Code if not U.S.)
Zip+4 (or Postal Code if not U.S.)
AD-3b.
phone
(U.S. phone
numbers
only) only)
AD-3a. Cell
Home
telephone
(U.S. phone
numbers
@
AD-4.
AD-3b. Email
Cell phone (U.S. phone numbers only)
This must be a valid address that you check regularly. If it changes, notify Admissions promptly.
@
AD-4. Email
This must be a valid address that you check regularly. If it changes, notify Admissions promptly.
Citizenship & Residency
(CR)
CR-1.
Birthplace City and State
Citizenship
& Residency
(CR)
CR-2.
CR-1.
Are
you a U.S.
Birthplace
Citycitizen?
and State  Yes: skip the next three questions.
 No: go on toCountry
the next
question.
if other
than U.S.
CR-3.
CR-2.
What
is your
of citizenship?
Are you
a U.S.country
citizen?
 Yes: skip the next three questions.
 No: go on to the next question.
CR-4.
CR-3.
What is your country of permanent
citizenship?residence?
Specify
Specify country
country
CR-5.
CR-4.
Current
or Expected
Visa
Type or Immigration
What is your
country of
permanent
residence? Status
Specify country
CR-5.

U.S. Permanent
Resident/Immigrant
Visa Registration
Current
or Expected
Visa Type or Immigration
Status Number: A#
Date issued/to be issued mm
yyyy
 Refugee
 Political
Asylee
U.S. Permanent
Resident/Immigrant
Visa Registration Number: A#
Date issued/to be issued mm
yyyy





Country if other than U.S.
Specify country
International
Student:Asylee
visa types F, J or B, H, L, M, R, TD, TN
Refugee  Political
This is the wrong application. You need to complete the international application, available online at admit.uw.edu/Apply/International/Apply
International
Student: visa types F, J or B, H, L, M, R, TD, TN
or
contact Admissions.
This is the wrong application. You need to complete the international application, available online at admit.uw.edu/Apply/International/Apply
Other
Visa Admissions.
Types (A,E,G,I,K,V) Visa Type and Number e.g., A-2, E-2, E-3, V-3
Date visa became (or will become) effective mm
or
contact
 Other:
any Types
status(A,E,G,I,K,V)
not included above
________________________________________________________________________________
Other Visa
Visa Type
and Number e.g., A-2, E-2, E-3, V-3
Date visa became (or will become) effective mm
yyyy
yyyy
CR-6.
Are
you a resident
of not
Washington
 No  Yes: If yes, you must include dates of your most recent continuous residence in Washington State.
 Other:
any status
included State?
above ________________________________________________________________________________
CR-6.
From
mma resident ofyyyy
to If
mm
________
_________
Are you
Washington State? to  Present
 Noor Yes:
yes,
you mustyyyy
include
dates of your most recent continuous residence in Washington State.
From mm
yyyy
Special Programs
to  Present or
 to mm ________ yyyy _________
(SP)
SP-1.
Will you be enrolling
under the UW(SP)
Faculty / Staff Tuition Exemption Program or Washington State Employees’ Tuition Exemption Program?
Special
Programs
 Yes  No
SP-2.
SP-1.
Would
you
information
at the Exemption
UW?
 Yes
 No
Will you
belike
enrolling
under about
the UWveterans
Faculty benefits
/ Staff Tuition
Program
or Washington
State Employees’ Tuition Exemption Program?
 Yes  No
SP-3.
SP-2.
Have
in foster careabout
in Washington
State foratatthe
least
Wouldyou
youbeen
like information
veterans benefits
UW?one year since
 your
Yes 16th
 Nobirthday?
 Yes  No
SP-3.
Have you been in foster care in Washington State for at least one year since your 16th birthday?
 Yes  No
UW Seattle Freshman Application A2
UW Seattle Freshman Application A2
UW Seattle Transfer Application A2
Family Information
(f)
Residents of Washington State under the age of 25 must provide information about at least one parent or legal guardian, preferably both. This information is
required to determine residency classification. Omission of parent/guardian information will result in classification as a nonresident. All applicants are urged to
respond to as many of the questions in this section as possible. family information provides context for better understanding an applicant’s educational environment
and circumstances. The information you provide in this section will not disadvantage you in the admission process in any way.
Parent / Legal Guardian
F-1a.
 Mr. 1  Ms. 2  Mrs. 3  Dr. 4  Rev. 5  Other: 6
F-1b.
Name
specify
Last (family) Name
first (Given) Name
F-1c.
 Primary parent/guardian for contact with the UW
F-3.
Is s/he living?  Yes  No: skip to f-8.
F-6.
Address
Middle
F-2. Relationship to you?  Mother 1  father 2  Guardian 3  Other: 4
F-4. Telephone
 Same as Mailing Address provided in AD-1
Jr., etc.
specify
F-5. Email
 Same as Permanent Address provided in AD-2
 Different:
Number and Street
Apt.
City
State (Province/Territory + Country if not U.S.)
Zip+4 (or Postal Code if not U.S.)
F-7.
Washington State resident?  No  Yes: from mm ________ yyyy _________ to  Present or  to mm ________ yyyy _________
You must include the dates of parent/guardian’s most recent continuous residence in Washington State.
F-8.
What is parent/guardian’s highest level of formal education completed? (check one)
 Did Not Graduate High School 1  HS Graduate 2  Some College but No Degree 3  2-Year Coll. Degree 4  4-Year Coll. Degree 5  Postgraduate Study 6
F-9.
If s/he attended college, list college(s) and degree(s):
College
U.S. STATe
CoUnTRy
yeAR fRom
(yyyy)
yeAR To
(yyyy)
F-10.
Did s/he attend the University of Washington?  Yes  No
F-12.
Do you authorize the release of information in your admission file to the parent/guardian named in f-1b?  Yes
DegRee
F-11. Occupation
 No
Parent / Legal Guardian
F-13a.  Mr. 1  Ms. 2  Mrs. 3  Dr. 4  Rev. 5  Other: 6
specify
F-13b. Name
Last (family) Name
first (Given) Name
F-13c.  Primary parent/guardian for contact with the UW
F-15.
Is s/he living?  Yes  No: skip to f-20
F-18.
Address
Middle
F-14. Relationship to you?  Mother 1  father 2  Guardian 3  Other: 4
F-16. Telephone
 Same as Mailing Address provided in AD-1
Jr., etc.
specify
F-17. Email
 Same as Permanent Address provided in AD-2
 Different:
Number and Street
Apt.
City
State (Province/Territory + Country if not U.S.)
Zip+4 (or Postal Code if not U.S.)
F-19.
Washington State resident?  No  Yes: from mm ________ yyyy _________ to  Present or  to mm ________ yyyy _________
You must include the dates of parent/guardian’s most recent continuous residence in Washington State.
F-20.
What is parent/guardian’s highest level of formal education completed? (check one)
 Did Not Graduate High School 1  HS Graduate 2  Some College but No Degree 3  2-Year Coll. Degree 4  4-Year Coll. Degree 5  Postgraduate Study 6
F-21.
If s/he attended college, list college(s) and degree(s):
College
U.S. STATe
CoUnTRy
yeAR fRom
(yyyy)
yeAR To
(yyyy)
F-22.
Did s/he attend the University of Washington?  Yes  No
F-24.
Do you authorize the release of information in your admission file to the parent/guardian named in f-13b?  Yes
DegRee
F-23. Occupation
 No
UWSeattle
Seattlefreshman
Transfer Application UW
Application A3
Family Information (F) CONTINUED
F-25.
Income and Household Size. Providing this information will not disadvantage you. Dependent students should complete F-25a.
Independent students should complete F-25b. (Providing this information is optional but encouraged.)
F-25a. Dependent Students Only
Parents’/Guardians' Gross Annual Income.
(Estimate for current year if necessary.)
Family Size. Include parents/guardians, yourself,
and other dependents.
Most recent year completed _____________
$ ____________________.00
__________
Previous year _____________
$ ____________________.00
__________
Student’s Gross Annual Income. (Estimate for current year
if necessary. If married, include your spouse’s income.)
Student Family Size. Include yourself, spouse, and other dependents.
Most recent year completed _____________
$ ____________________.00
__________
Previous year _____________
$ ____________________.00
__________
F-25b. Independent Students Only
UWSeattle
SeattleFreshman
Transfer Application UW
Application A4
Schools & Colleges Attended (SC)
Schools Attended Outside the U.S.
SC-1. Have you ever attended school outside the U.S.?  No: skip the rest of SC-1.  Yes: complete all the other questions in SC-1.
Mark an X next to EACH grade you have attended outside the U.S. __ 1 __ 2 List all schools you attended outside the U.S. beginning with Grade 1.
__ 3 __ 4 __ 5 __ 6 __ 7 __ 8 __ 9 __ 10 __ 11 __ 12 __ 13 __ 14 __ 15 __ 16
NAME OF SCHOOL
LOCATION
GRADE LEVEL(S)
example:
CALENDAR YEAR
E.G. 2005-06
LANGUAGE OF
INSTRUCTION
West Island School
2007 - 2011
Mandarin
Hong Kong
9-12
SC-3. High School Graduation
Have you graduated — or will you graduate — from high school (not GED)?  Yes: mm/yyyy of Graduation  No: Highest grade level completed SC-4
Homeschool Have you ever participated in a homeschool program?  No  Yes: select all that apply: Grade(s)  9  10  11  12
SC-5. High School / Secondary Schools Attended List all high schools and secondary schools you have ever attended, are currently attending, or will attend before enrolling at the UW. Do not exclude or omit any,
regardless of how many credits you earn(ed) there or the nature of the program in which you were/are enrolled. Failure to disclose all schools may result in denial
of admission to the University.
CEEB CODE
NAME OF HIGH SCHOOL OR
SECONDARY SCHOOL
Last High School Attended
Other HIgh School(s) Attended (in reverse order of attendance)
LOCATION (CITY, STATE; COUNTRY IF OTHER THAN U.S.)
DATES OF ATTENDANCE (MM/YYYY)
FROM TO
IF GRADE 9-12,
SPECIFY GRADE LEVEL(S)
SC-6. Colleges/Universities Attended List all colleges and universities you have ever attended, are currently attending, or will attend before enrolling at the UW. Include colleges attended while also
enrolled in high school programs such as Running Start, college in the high school, etc. Do not exclude or omit any institutions, regardless of how many credits you
earn(ed) there or the nature of the program in which you were/are enrolled. Failure to disclose all colleges and universities may result in denial of admission to the
University. Attach an additional page if necessary.
CEEB CODE
NAME OF COLLEGE, UNIVERSITY, ETC.
Last College Attended
Other College(s) Attended (in reverse order of attendance)
LOCATION (CITY, STATE; COUNTRY IF OTHER THAN U.S.)
DATES OF ATTENDANCE (MM/YYYY)
FROM TO
UW Seattle Transfer Application A5
Admission Tests
(AT)
Admission Tests. You are required to have official test scores sent directly from the testing agency by the application deadline; official test scores are
received electronically. Scores coming from a source other than the testing agency, e.g., your high school, are not acceptable and will not be considered.
Only report the best overall score from a single sitting (test date).
NOTE: If your Social Security Number (SSN) is not included on your ACT with Writing or SAT report, the scores may not automatically match to your UW application
record and it will take longer to manually match your scores with your application record.
AT-1. Check the box(es) of the tests you've taken or plan to take, then answer the follow-up questions for each test.
 SAT Reasoning Test
Have you already taken this test?  Yes: Go to DATE TAKEN
 No: Go to DATE TO BE TAKEN
DATE TAKEN (mm/yyyy)
DATE TO BE TAKEN (mm/yyyy)
Will your test report include your SSN?  Yes  No
Will your test report include your SSN?  Yes  No
Scores sent to UW?  Yes  No
Write here your name exactly as it will appear on this test:
Write here your name exactly as it appears on this test:
Last (Family Name)
Last (Family Name)
First (Given Name)
First (Given Name)
Middle (if any)
Middle (if any)
 Check this box if your name on this test appears exactly
the same as the name on this application.
Are your test score results available?  Yes  No
TOTAL
Scores
Verbal or Critical Reading
Math
Writing
Do you plan to take this test again?  Yes  No
DATE TO BE RE-TAKEN (mm/yyyy)
 ACT with Writing
Have you already taken this test?  Yes: Go to DATE TAKEN
 No: Go to DATE TO BE TAKEN
DATE TAKEN (mm/yyyy)
DATE TO BE TAKEN (mm/yyyy)
Will your test report include your SSN?  Yes  No
Will your test report include your SSN?  Yes  No
Scores sent to UW?
 Yes  No
Write here your name exactly as it will appear on this test:
Write here your name exactly as it appears on this test:
Last (Family Name)
Last (Family Name)
First (Given Name)
First (Given Name)
Middle (if any)
Middle (if any)
 Check this box if your name on this test appears exactly
the same as the name on this application.
Are your test score results available?  Yes  No
TOTAL
Scores
Composite Score
Writing Score
Do you plan to take this test again?  Yes  No
DATE TO BE RE-TAKEN (mm/yyyy)
UWUW
Seattle
Freshman
Seattle
TransferApplication
Application A11
A6
College Courses in Progress (CC)
CC-T1. It is very important that you list all college courses you are taking or plan to take between now and when you plan to attend the UW. List only those courses that
will not appear on the college transcripts you are having sent to the UW. Attach an additional page if necessary. Autumn Term ____ Yr
 Qtr  Sem
College: Winter Term ____ Yr
Spring Term ____ Yr
 Qtr  Sem
College:  Qtr  Sem
College: Summer Term ____ Yr
 Qtr  Sem
College: �������������������������
PREFIX & NO. SHORT TITLE CREDITS PREFIX & NO. SHORT TITLE CREDITS PREFIX & NO. SHORT TITLE CREDITS PREFIX & NO. SHORT TITLE CREDITS
example:example: example: example:
ENGL 101 Freshman Comp
5
CHEM 121
Advanced-Level Credit Gen Chem
4
SOC 101 Intro to Sociology
5
POL SCI 120 American Govt
5
(AL)
AL-1. Have you already earned — or do you expect to earn — any advanced-level credit (e.g., A-level, STMP, HKALE, Arbitur, etc.,) before enrolling at the
University of Washington? Do not include AP or IB credit.  No  Yes: Please specify Certificate, Diploma, or Advanced Credit and date.
NAME OF SCHOOL
ex: Singapore
CERTIFICATE/DIPLOMA/ADVANCED CREDIT
American School Degrees Earned or Expected A-Level
DATE AWARDED OR EXPECTED (mm/yyyy)
05/2010
(DG)
DG-1. Have you already earned — or do you expect to earn — an associate or bachelor’s degree before entering the University of Washington?  No  Yes: specify degree and date expected.
COLLEGE
ex: Yakima
Valley CC NAME OF DEGREE
Associate of Arts & Sciences
DATE OF DEGREE EARNED OR EXPECTED
June 2011
UW Seattle Transfer Application A7
Additional Information
AI-1.
(AI)
Would you like to explain or clarify any answers in your application? Yes No
Use this space if you need to explain or clarify any answers you have given in this application or to provide additional information that may assist the Office
of Admissions. Be sure to include the question number to which your comment refers. (maximum 500 words)
Please do NOT use this space to write or add to your Personal Statement.
Checklist
CL-1.
(CL)
Checklist
I understand that a complete application, which includes the following materials, must be submitted by the application deadline:
 This application including Personal Statement
 $60 nonrefundable application fee
 Official high school transcript
 One official transcript from each college or university attended
Optional:
Test
Scores
(SAT
and/or
ACT) sent
directly
from
the testing
agency from the testing agency. Test scores are
 Official
test
scores
from
SAT
Reasoning
Test or
ACT with
Writing,
sent directly
required of applicants with fewer than 40 transferable credits completed at the time of application.
Signature
SS-1.
(SS)
In signing this form, I certify that the statements I have made in this application are complete and true to the best of my knowledge. I acknowledge
that it is my responsibility to be aware of all pertinent admission and application requirements and that I have read and understand the application
instructions. I acknowledge that failure to disclose complete and accurate information, or failure to submit all required application information —
including those outlined in the Checklist CL-1 — may result in the denial of admission or subsequent dismissal from the University of Washington.
I understand that my complete application must be signed and submitted by the application deadline to be considered for admission.
Signature of Applicant ____________________________________________________________________
2034875.EDApp12 / 12.28.2011
Date ___________________
UW Seattle Transfer Application A8
Statistical Information (ST)
APPLICANT'S NAME
DATE OF BIRTH mm dd yyyy
The University is required by the U.S. Department of Education to ask you about your ethnic identity.
The information you provide also allows the University of Washington to do the following:
1) We can report aggregate demographic data to state and federal agencies as required by law.
2) We can monitor the effectiveness of our recruitment and outreach efforts.
3) The information may assist in the awarding of privately funded diversity scholarships.
This information will be separated from your application file and will not be used in the admission review process.
ST-1.
Are you of Hispanic or Latino origin? (Check all that apply.)
 No 999
 Yes, In addition, select from the following:
 Mexican or Mexican American or Chicano 722
 Peruvian 726
 Argentinian 700
 Puerto Rican 727
 Chilean 706
 Salvadoran 712
 Colombian 707
 Spanish/Spaniard 730
 Cuban 709
 Hispanic 717
 Other Hispanic or Latino: 739
(Specify, e.g., Ecuadoran, etc.)
ST-2. Additionally, what race(s) do you consider yourself? Regardless of your answer to the previous question,
please mark the following box(es) to indicate what you consider yourself to be.
 African American or Black 870
 Alaska Native or American Indian 599
If possible, please specify tribal or corporate affiliation Verification of tribal or corporate affiliation is recommended.
(e.g., Shoshone)
UW departments and programs are encouraged to consider tribal or corporate enrollment or affiliation as a positive factor in admission,
financial aid, and outreach programs. Verification of affiliation — which is required in order to benefit — consists of one of the following:
f
Official tribal identification. Examples: copy of a tribal enrollment card, treaty fishing card, corporation papers,
or Bureau of Indian Affairs (BIA) document.
f
Certificate of membership verification by the BIA, a tribal enrollment official, community official or proof of direct descendancy.
 Asian American. In addition, select from the following:
 Asian Indian 600
 Laotian 613
 Bangladeshi 601
 Malaysian 614
 Cambodian 604
 Pakistani 616
 Chinese 605
 Singaporean 637
 Filipino 608
 Sri Lankan 617
 Hmong 609
 Taiwanese 606
 Indonesian 610
 Thai 618
 Japanese 611
 Vietnamese 619
 Korean 612
 Asian American 621
 Other Asian American: 986
(Specify, e.g., Mongolian, etc.)
 Caucasian or White 800
 Pacific Islander. In addition, select from the following:
 Fijian 676
 Native Hawaiian 653
 Guamanian or Chamorro 660
 Samoan 655
 Marian Islander 661
 Tongan 657
 Melanesian 677
 Pacific Islander 681
 Other Pacific Islander: 985
(Specify, e.g., Palauan, etc.)
 Micronesian 669
UW Seattle Transfer Application A9