Undergraduate Application for Returning Students

I AM APPLYING FOR THE
FALL SEMESTER 20
SPRING SEMESTER, 20
1ST SUMMER TERM, 20
2ND SUMMER TERM, 20

RESIDENCY (Issues and Oath)
1.    Were you enrolled at Angelo State University when you were called to active military duty? Yes No
2.    Are you a U.S. Citizen? Yes No
       If not, do you hold a Permanent Residence status for the U.S.? Yes No
       If yes, date permanent resident card issued Number
3.    Are you claiming Texas residence status? Yes No
       Upon whom are you basing your claim of residence? Self Parent Legal Guardian (guardianship papers must be provided)
4.    If your claim of residence is based upon self, answer the following questions:
       How long have you resided in Texas? Years and Months
       Previous state or country of residence
       If you moved to Texas within the past 5 years, give reason for move.
        Education
        Employment
        Military Assignment
        Other (please specify)

       If Military, what is your home of record with the U.S. Armed Forces?
5.    If your claim of residence is based upon parent or legal guardian, answer the following questions:
       Name of person upon whom claim is based:
       Relationship to self: Parent Legal Guardian
       How long has this person resided in Texas? Years and Months
       Previous state or country of residence:
       If this person moved to Texas within the past 5 years, give reason for move:
        Employment
        Military Assignment
        Other

       If Military, what is this person’s home of record with the U.S. Armed Forces?
       Is this person a U.S. citizen? Yes No
       Has parent or legal guardian claimed you as a dependent for U.S. federal income tax purposes for the tax year preceding
       your registration? Yes No
       Will this person claim you for the current tax year? Yes No

Additional Information
1. Are you currently Active Duty Military? Yes No
2. Will you be seeking a degree from Angelo State? Yes No
3. Will you be seeking a Teaching Certificate from Angelo State? Yes No
4. Are you a dependent of an Active Duty member? Yes No
5. Are you a transient student? Yes No
6. Have you ever been suspended, dismissed or forcibly withdrawn from an institution for non-academic reasons?
Yes No
7. Have you ever been convicted of any crime other than a minor traffic violation? Yes No

I certify that this information is complete and correct to the best of my knowledge. If my application is accepted, I agree to abide by the policies, rules, and regulations at Angelo State University. I authorize the university to verify the information I have provided. I further understand that this information will be relied upon by the officials of the university in determining my admissions and residence status for tuition purposes and that the submission of false information is grounds for rejection of my application, withdrawal of an offer of acceptance, cancellation of enrollment, and/or disciplinary action. I also authorize the university to electronically access my Texas Success Initiative Assessment results.

Directory information may be released to the general public without written consent of the student. Directory items include the student's name, address, major, activities participated in, dates of attendance, degrees, and awards received. If you wish to have information withheld, please sign below.

APPLICATION FEE
PAYMENT
Check
Money Order
Credit Card
CC#:
Exp. Date: /
Authorized Signature:

PREVIOUSLY PAID

Street Address or P.O. Box
City
State
Zip

	RETURNING STUDENT (FORMER STUDENTS)

	UNDERGRADUATE APPLICATION
	FOR ADMISSIONS

	College/Universities Attended	City/State	Dates of Attendance	Degree Awarded
1.
2.
3.
4.

Last Name
First Name
Middle Name or Initial: