Today's Date: November 21, 2009 (submitted with application)

THIS APPLICATION IS FOR THE FOLLOWING:

Full-Time (12 or more cr./semester)
Part-Time (up to 11 cr./semester)

I am interested in the HEOP/EOP Programs.
Are you currently a participant in an HEOP/EOP program? Yes No

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PERSONAL DATA

Legal Name

Female     Male

Social Security Number
--

Date of birth: (mm/dd/year)

Place of birth:

Email Address

Citizen of United States?
Yes
  If yes, state of legal residence
  County/parish within state
No
  If no, country of citizenship

Will you require a student visa? Yes No
If no, please indicate the type and number of your visa

Have you ever been convicted of a felony? Yes No
If yes, please explain in a personal statement.

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OPTIONAL INFORMATION: Ethnic origin. This data is solely voluntary. The information will be kept confidential and refusal to provide this information will not subject the applicant to any adverse treatment.

Other, specify

First language, if not English

Father's Place of Birth

Mother's Place of Birth

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FAMILY DATA

Are your parents separated or divorced? Yes No

If yes, with whom do you live? Father Mother

If not with your parents, with whom do you make your permanent home?

Number of brothers and sisters
If applicable, list the colleges they attend.

List names, class year, and relationships of Alfred University alumni relatives.

Marital status Single Married
If married, are you separated or divorced? Yes No

If applicable:

Spouse's name

Is spouse living?
Yes No

Spouse's occupation and title

Name of business

Business address

Business phone
() -

Spouse's home address

Spouse's home phone
() -

Spouse's college, if any

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SECONDARY SCHOOL DATA

Secondary School Attended

Name
Address
Dates Attended

Secondary School CEEB Number

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WORK EXPERIENCE

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ACADEMIC AND SOCIAL DATA

Are you in good academic standing at the college you are currently attending or most recently attended?
Yes No

Are you eligible to return to the last college that you attended?
Yes No
If no, explain

Reasons for transferring:

Do you have a college degree?
Yes No
If yes: Associate BachelorOther

If not, will you have a degree before entering Alfred University?
Yes No
If Yes: Associate BachelorOther
Date that degree was/will be granted: (mm/dd/year)

List colleges in order of dates attended, with the most recent college attended listed first. You must request official transcripts from from each college and send them to the Coordinator of Transfer Admissions.

List all current and/or future course work.

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CO-CURRICULAR AND PERSONAL ACTIVITIES

Please list your primary co-curricular and community activities. Include specific events and/or major accomplishments. Please use the right hand column to indicate those activities you wish to pursue while attending Alfred University.

Please list other activities you would like to become involved with at Alfred.

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OTHER INFORMATION

Do you plan to request financial aid from Alfred University? Yes No
If yes, you should file the required Free Application for Federal Student Aid (FAFSA) as soon as possible after January 1. Financial Aid Transcripts must be sent from all previous colleges to the Alfred Financial Aid Office. For further information, call the Financial Aid Office: 607.871.2159.

Are you a member of Phi Theta Kappa? Yes No

Have you visited the campus? Yes No

Please indicate how you first became interested in Alfred University.

List other colleges to which you have applied or will apply for admission (Optional).

Have you met with an Alfred University representative? Yes No
Whom and where?

Have you met with an Alfred University alumnus/a? Yes No
Whom and where?

After completing the Transfer Application Form, click the "Submit Application" button, and your information will be forwarded to the admissions office at Alfred University. Also, make sure that you print out and complete the Supplementary Application.

If you wish to start over, click the "Clear All" button to clear all of the information entered.

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