Application for Arizona Western College and Northern Arizona by xuh86054

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									                                        Application for
                                   Arizona Western College
                                             and
                      Northern Arizona University – Yuma Branch Campus
                                        Joint Program

Joint Program
By filling out this application you become part of a special alliance between Arizona Western College and Northern
Arizona University. This joint program puts students on their way toward earning a baccalaureate degree. Some of the
benefits include:

        Academic advising from both institutions from the time you are accepted into the program.
        Obtain a Northern Arizona University student identification card.
        AWC and NAU e-mail addresses.
        Discounts throughout the community with your NAU ID card.
        No application fee.

Joint Program Requirements
All students applying for the joint program must be enrolled at Arizona Western College as a first time freshman with the
intention of earning a baccalaureate degree. You must meet high school entrance requirements, complete the Arizona
General Education Curriculum (AGEC), or earn an associate’s degree before you can transition entirely to Northern
Arizona University. Upon acceptance to Northern Arizona University, some programs of study will require a separate
application and additional entrance requirements.

General Information
        Complete all information and sign the application.
        Submit official high school transcripts, if not on record with Arizona Western College to:

                                          Student Services
                                          c/o Northern Arizona University–Yuma Branch Campus
                                          PO Box 6236
                                          Yuma, AZ 85366-6236

        You may be requested to submit SAT or ACT test scores upon review of your application.
        The $25 application fee is waived.
        If you need assistance with the application, please contact Eileen.Knight@nau.edu or 928-317-6431.
                                Application for
                           Arizona Western College
                                     and
              Northern Arizona University – Yuma Branch Campus
                                Joint Program

COMPLETE ALL ITEMS. Please print in ink or type.
FULL LEGAL NAME:
                            LAST NAME                      FIRST NAME                               MIDDLE NAME

SOCIAL SECURITY NUMBER:
                            Disclosure of your Social Security number is required for tax purposes under the Tax Relief Act of 1997. A
                            random generated number will be used to maintain your records during your enrollment.

Former Name:
(if applicable)             LAST NAME                     FIRST NAME                                MIDDLE NAME

HOME/PERMANENT ADDRESS:
                            NUMBER AND STREET NAME or BOX NUMBER                        APT #


                            CITY                          STATE                                     ZIP CODE

MAILING ADDRESS:
(if different from above)   NUMBER AND STREET NAME or BOX NUMBER                        APT #


                            CITY                          STATE                                     ZIP CODE

CITIZENSHIP STATUS:           United States
(select one)                  Resident Alien*
                              Refugee*
                              Asylee*
                                    * attach appropriate documentation

GENDER:                        Male                 Female

DATE OF BIRTH:
                            MONTH - DAY - YEAR

VETERAN:                      NO                   YES


E-MAIL ADDRESS:

PERMANENT TELEPHONE:
                            EVENING                                  DAYTIME                                            CELL

EMERGENCY CONTACT:
                            NAME


                            NUMBER AND STREET NAME or BOX NUMBER                                              APT#


                            CITY                                     STATE                                    ZIP CODE


                            TELEPHONE                                                                         CELL
ETHNICITY: (please mark all that apply)

                 1.         Are you Hispanic/Latino? _______Yes _______No
                 2.         Are you (check all that apply):
                            _____ Black (African American)
                            _____ American Indian/Alaska Native *
                            _____ Asian
                            _____ Native Hawaiian or Other Pacific Islander
                            _____ White (Caucasian)

                            * If you marked American Indian/Alaska Native, specify tribal/corporate affiliation(s):
                               _______________ Tribal/Corporate affiliation
                               _______________ Tribal/Corporate affiliation
                               _______________ Tribal/Corporate affiliation

MAJOR INFORMATION
Your NAU – Yuma Branch Campus intended major (see list on the last page) _______________________________________

EDUCATION INFORMATION
HIGH SCHOOL INFORMATION:
Name of high school from which you graduated:                                                  City:                    State:

Date of high school graduation (MONTH-YEAR):                             Home schooled:          Yes       No

EXAMS:                ACT     SAT       GED         Date Taken:                      State:

COLLEGE INFORMATION: List all colleges attended

Name of college: ________________________City:________________________State:______ Dates attended: _________________

Name of college: ________________________City:________________________State:______ Dates attended: _________________

Name of college: ________________________City:________________________State:______ Dates attended: _________________

PARENT INFORMATION
Has either of your parents ever attended college?                           No          Yes

FATHER:          Name:
                                     LAST                         FIRST                       MIDDLE
                 Address:
                                     NUMBER AND STREET NAME or BOX NUMBER

                                     CITY                         STATE                       ZIP CODE
                 Telephone:
                                     EVENING                      DAYTIME                     CELL
                 E-mail address:

                 List college(s) attended:

                 Degree(s) earned, if applicable:          Associate’s           Bachelor's            Master's       Doctorate

                 Employer:                                                       Job Title:

MOTHER:          Name:
                                     LAST                         FIRST                       MIDDLE
                 Address:
                                     NUMBER AND STREET NAME or BOX NUMBER

                                     CITY                         STATE                       ZIP CODE
                 Telephone:
                                     EVENING                      DAYTIME                     CELL
                 E-mail address:

                 List college(s) attended:

                 Degree(s) earned, if applicable:          Associate’s           Bachelor's            Master's       Doctorate

                 Employer:                                                       Job Title:
ARIZONA RESIDENCY VERIFICATION

All applicants must complete this entire section. Your residency classification is your status as of the date of application. Failure
to answer any question in this section will result in a classification of non-resident. (Put N/A if not applicable).

          Are you, your spouse or parent(s) on active duty stationed in Arizona on military orders, or a member of the Arizona National
          Guard, or a member of a Reserve unit based in Arizona?             NO        YES

          Are you, your spouse or parents(s) on active duty stationed outside of Arizona and claim Arizona residency?                         NO      YES

          Do you currently live on a reservation in Arizona or partially in Arizona?               NO         YES

          Do you consider yourself a resident of Arizona?                                          NO         YES

          Are you entirely self supporting?         NO      YES (if someone else claimed you as a dependent for tax purposes, answer no)


          IF NO (you are dependent):
                   When did you start residing in Arizona (month and year)_________
                   Will or did you graduate from a high school in Arizona?              NO     YES
                   Are your parents or guardians residents of Arizona?             NO      YES (check yes if YOU live with a parent in Arizona)
                   Does one of your parent or guardian file an Arizona income tax return as an Arizona resident?                     NO     YES
                         o    If yes, when was the last filing year? _______
                   Do your parents or guardians maintain a driver’s license or vehicle registration in a state OTHER THAN Arizona?
                      NO      YES


          IF YES (you are independent):
                   When did you start residing in Arizona (month and year)_________
                   Do you file an Arizona income tax return as an Arizona resident?                NO       YES
                         o    If yes, when was the last filing year? _______
                         o    If no, have you filed a tax return in a state other than Arizona?           NO       YES
                   Do you maintain a driver’s license or vehicle registration in a state OTHER THAN Arizona?                      NO      YES




By signing, I represent that the information provided in this application is correct, true and complete. I understand that if I am
found to have made false or misleading statements on this application, I may be subject to discipline, including dismissal from
the university.

I grant Northern Arizona University permission to contact all schools I attended to request transcripts. I grant Arizona Western
College permission to provide unofficial transcripts to NAU upon their request.

Signature of Applicant                                                                                                     Date


Northern Arizona University is an equal opportunity/affirmative action institution and does not discriminate on the basis of race, color, religion, sex,
national origin, age, handicap, or veteran status in its programs and activities. Northern Arizona University complies with Title IX of the Education
Amendment of 1972.
     Northern Arizona University – Yuma Branch Campus Majors

                    Administration
                    Biology
                    Business Administration
                    Criminal Justice
                    Elementary Education
                    Environmental Science
                    Interdisciplinary Studies
                    Psychology
                    Public Agency Management
                    Secondary Education
                    Social Work
                    Sociology
                    Spanish
                    Technology Management




Freshman Requirements:
                                                                               COLLEGE PREPARATORY (HIGH SCHOOL) COURSES:
ARIZONA RESIDENTS:                                                                4 years of college preparatory English
Arizona residents will be offered admission if they meet the following:           4 years of Math, including Algebra I & II, Geometry, and any advanced
3.00 or higher core GPA* (on a 4.0 scale), or a 22 ACT score, or a                math course for which Algebra II is a prerequisite
combined verbal and math only score of 1040 on the SAT I, or top 50               3 years of laboratory Science – one in three of the four areas of
percent class rank and no deficiencies in the required college                    Biology, Chemistry, Physics, Earth Science
preparatory courses (listed at right).                                            2 years of Social Science – one year must be American History
                                                                                  2 years of one Foreign Language
Arizona residents will be considered for admission if they meet the               1 year of Fine Arts
following: 2.50–2.99 core GPA* (on a 4.0 scale) or top 50 percent class
rank, and have no more than one deficiency in any two subject areas in the     Home schooled and charter school applicants must meet aptitude
required college preparatory courses (listed at right). Students with both a   requirements through ACT or SAT I composite test scores. ACT score of
math and lab science deficiency are not admissible.                            22 (Arizona resident) or 24 (non-resident) or SAT I score of 1040 (Arizona
                                                                               resident) or 1110 (non-resident). Note: only the math and verbal portions
NON-RESIDENTS:                                                                 of the SAT I will be used when processing test scores for admissions.
Non-resident students will be offered admission if they meet the following:
3.00 or higher core GPA* (on a 4.0 scale), or a 24 ACT score, or a             GED applicants must submit an official score report from the applicable
combined verbal and math only score of 1110 on the SAT I, or top 25            state department of education and must have a minimum composite score
percent class rank and no deficiencies in the required college preparatory     of 50.
courses (listed at right).

Non-resident students will be considered for admission based on
                                                                               *    Core GPA is calculated using only the 16 required college
individual circumstances and/or space availability if they meet the                preparatory courses listed above.
following: 2.50–2.99 core GPA* (on a 4.0 scale) or top 50 percent class
rank and have no more than one deficiency in any two subject areas in the
required college preparatory courses (listed below). Students with both a
math and lab science deficiency are not admissible.

								
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