Undergrad Application for University of Baltimore Maryland

					                      S P E C I A L / N O N - D E G R E E S E E K I N G ST U D E N T U N D E R G R A D U AT E A P P L I C AT I O N

                                                                             Please use this form only if you have previously been
                                                                             enrolled as an undergraduate at UMBC.

At UMBC, every student has           Applicants who previously have       Deadlines                             Campus Security Notice
access to exceptional resources,     received a bachelor’s degree
                                                                          The deadline for submitting a         In compliance with the “Jeanne
stimulating teachers and             may be admitted as non-degree
                                                                          Special/Non-Degree Seeking            Clery Disclosure of Campus
individual attention. Faculties      seeking (special) students without
                                                                          application are as follows:           Security Policy and Campus
working on the frontiers of their    submitting college transcripts.
                                                                                                                Crime Statistics Act,” information
fields bring the latest advances     Other students must submit           Fall – First Day of Classes
                                                                                                                regarding crime statistics, policies
into the classroom. Students         high school and/or college           Spring – First Day of Classes         pertaining to campus security,
are friendly and hardworking,        transcripts and must meet
                                                                                                                crime reporting, alcohol and drug
with high aspirations. When they     regular admission standards.         UMBC’s Non-Discrimination
                                                                                                                violations, victims’ assistance
graduate, they find positions with                                        Statement
                                     Visiting students—individuals                                              programs, student discipline,
top employers and attend many                                             “The University of Maryland,
                                     who are in good standing at                                                campus resources, community
of the leading graduate schools                                           Baltimore County does not
                                     another college and who plan to                                            safety alerts, crime prevention,
in America. If this sounds like                                           discriminate on the basis of race,
                                     attend UMBC for one semester                                               access to campus facilities and
the kind of college experience                                            color, religion, national origin,
                                     only—may be considered for                                                 personal safety tips is contained
you want, we hope you will apply.                                         ancestry, ethnic background,
                                     admission by submitting a                                                  within the UMBC Annual Campus
We will be happy to answer any                                            genetics, disability, age, sex,
                                     transcript, grade reports or a                                             Security Report available online
questions you have about UMBC.                                            marital status, sexual orientation
                                     letter of good standing from                                               at the Police Department’s Web
Individuals who wish to enroll in    their current institution.           and/or veteran status in              site, by in person or by calling
undergraduate classes at UMBC                                             admission to and participation        UMBC Police at 410-455-5555.
                                     Academic advisement is not a
as a visiting or non-degree-                                              in education programs and
                                     prerequisite for registration for
seeking student should review                                             activities, or employment
                                     non-degree seeking students.
the information below and submit                                          practices in accordance with
                                     Students wishing to consult with
an application online or in person                                        federal laws, including, but not
                                     an academic advisor regarding
to the Office of Undergraduate                                            limited to Titles VI and VII of the
                                     course selection may contact
Admissions & Orientation.                                                 Civil Right Act, Title IX of the
                                     either the department offering
                                                                          Education Amendments, Section
Non-Degree Seeking Students          the course or the Office of
                                                                          504 of the Rehabilitation Act, and
must submit the following to         Academic and Pre-professional
                                                                          the Americans with Disabilities
be considered for admission:         Advising at 410-455-2729.
                                                                          Act as amended, as well as
• A completed Non-                   Students register for classes        state laws, and regulations.”
  Degree Seeking (Special)           electronically via myUMBC.
  Student Application                To access myUMBC, admitted
                                     students must create an
• A $50 non-refundable
                                     online account. Non-degree
  application fee
                                     seeking students are eligible
• College transcripts (Unofficial    to register during the Special/
  records will be considered.)       Non-Degree student registration
If fewer than 30 semester            periods. For information about
hours of college coursework          registration eligibility timeline
have been completed, the             for new and continuing Special/
applicant also must submit           Non-Degree students, visit
a high school transcript and         the registration calendar in
SAT or ACT scores (unless the        the schedule of classes.
applicant has been out of high
school three years or more).
Frequently Requested               Student Support Services
UMBC Information                   410-455-3250
                                   WEB: www.umbc.edu/sss
410-455-2291                       Summer and Winter Programs
FAX: 410-455-1094                  410-455-2335
WEB: www.umbc.edu/                 WEB: www.cps.umbc.edu
undergraduate                      TTY for Hearing Impaired
Academic and                       410-455-3283
Pre-professional Advising          Veterans Affairs
410-455-2729                       410-455-2387
WEB: www.umbc.edu/                 WEB: www.umbc.edu/
registrar/advising                 financialaid/veterans
Bookstore                          Please submit completed
410-455-2665                       application to:
WEB: www.umbc.edu/bookstore
                                   Office of Undergraduate
Bursar/Student Billing             Admissions and Orientation
www.umbc.edu/sbs                   University of Maryland,
Career Services Center             Baltimore County
410-455-2216                       1000 Hilltop Circle
WEB: www.careers.umbc.edu          Baltimore, MD 21250
Counseling Center
WEB: www.umbc.edu/counseling
Financial Aid and Scholarships
FAX: 410-455-1094
WEB: www.umbc.edu/financialaid
Information (Campus-wide)
International Education Services
WEB: www.umbc.edu/ies
Learning Resources Center
WEB: www.umbc.edu/lrc
WEB: www.umbc.edu/library
Parking Services
WEB: www.umbc.edu/parking
Police/Public Safety
WEB: www.umbc.edu/police
FAX: 410-455-1141
WEB: www.umbc.edu/registrar
Residential Life
WEB: www.umbc.edu/reslife
                              S P E C I A L / N O N - D E G R E E S E E K I N G ST U D E N T U N D E R G R A D U AT E A P P L I C AT I O N
University of Maryland, Baltimore County

Please print carefully in ink. Complete all sections.
Do not write in shaded areas.
Have you previously applied to UMBC?                  Yes      No
                                                                                                                This form should be completed only by non-degree-seeking applicants who wish
If yes,        Undergraduate           Graduate          Non-degree seeking
                                                                                                                to enroll for undergraduate courses. Please use the Application for Readmission
Term/Year Applied                              Dates of Attendance                                              if you have previously attended UMBC or are currently attending UMBC. A $50
                                                                                                                non-refundable check or money order made payable to UMBC must accompany
                                                                                                                this application. (Please do not send cash.) UMBC application materials and
                                                                                                                correspondence should be directed to the Office of Undergraduate
                                                                                                                Admissions, UMBC, 1000 Hilltop Circle, Baltimore, MD 21250.
Personal Information

1. First Name                                                 Middle Name/Initial                                                            Last Name/Family Name

   Other name(s) that may appear on your records
                                                                                                                                                                  To be considered for federal, state and institutional
                –            –                                                                                        –             –                             aid, a social security number (SSN) is required. This
                                                                                                                                                                  is not applicable to international students In addition,
                                                                                                                                                                  if you are due a refund for any reason during your
2. Date of Birth (Month/Day/Year)                       3. Gender:      Male         Female             4. Social Security Number                                 attendance at UMBC, a SSN is required for tax
                                                                                                                                                                  reporting purposes.

5. Number and Street of Current Mailing Address                                               Apt. #                                City                                                                       State

   ZIP Code                                             County (Maryland Residents)                                                     Country (if not U. S.)

                    –                 –                                         –                  –
6. Area Code/Home Telephone Number                              Cell                                                           7. E-mail Address

8. Country of Citizenship                                                                       Country of Birth

   Native Language                                                                               TOEFL taken?        Yes, date taken                               No       Not Applicable

   If not a U.S. citizen, please state current visa status:                                                              If you need a student visa please check one:           F1       J1

   If permanent resident of U.S., please provide: Alien Registration Number                                                   Date Issued                 Date of Expiration

9. Are you of Hispanic or Latino origin?       Yes      No        What is your race? Select one or more of the following categories:
                                                                   American Indian or Alaska Native       Asian       Black or African American              Native Hawaiian or Other Pacific Islander            White

Academic Interest and History
10. When do you plan to enroll?         Summer Sessions: 20               Fall: Sept. 20               Winter Session: 20             Spring: Jan. 20
     Do you wish to enroll only for the term indicated above? (visiting student)        Yes      No

11. High School Attended                                                                                    City/State                                            Graduation Year

12. List all institutions previously attended (include current enrollment and degrees earned/expected. Attach additional sheet if necessary.)
     Please provide a grade report, transcript (unofficial is acceptable) or a letter of good standing from the most recent institution.

                                                     COLLEGE/UNIVERSITY                                       LOCATION                                    ATTENDANCE                      CREDITS CREDITS DEGREE
                                                          ATTENDED                                          (CITY, STATE)                                   (MO/YR)                      ATTEMPTED EARNED EARNED

                                                                                                                                                    FROM                THROUGH


13. Are you currently attending the last institution mentioned above?          Yes      No

14. Have you ever been convicted or found guilty of any criminal or military offense, excluding minor traffic violations?       *    Yes       No

15. Have you ever been academically dismissed from, declared ineligible to attend or incurred disciplinary action at any previous institution?           *       Yes     No
     *Consistent with the federal Campus Security Act, questions 14 and 15 are required. If you answer “Yes” to either, please attach a letter of explanation.
          Include in that letter your name, social security number, and date(s) of incident(s).

16. I certify that the information on this application is complete and correct. If it is not, I understand that cancellation of admission and registration may result. I agree to abide by the rules, policies
    and regulations of UMBC, including those concerning drug and alcohol abuse, and I understand that the unlawful use of drugs or alcohol will subject me to the penalties contained in those
    policies and regulations.

     Signature of applicant                                                                Signature of parent if applicant is under 18                                              Date
In-State Tuition Status (applicants seeking in-state tuition status)
Failure to complete all of the required items may result in a non-Maryland resident classification and out-of-state charges being applied.

          I am a part-time (50%) or full-time regular employee of the University System of Maryland, or I am the spouse of, or am financially dependent upon a parent or legal guardian
          who is a regular employee of the University System of Maryland.
          Please indicate relationship:
          Please attach a letter of verification from the Human Resources Office of the campus at which you or your spouse or parent or legal guardian is employed.
          I am a full-time active member of the U.S. Armed Forces whose home of residency is Maryland, or one who resides or is stationed in Maryland, or the spouse or a financially
          dependent child of such a person.
          Please attach a copy of your deed or lease (if applicable), or verification from the service that you have declared Maryland as your “home of residency” (if applicable), and the
          most recent assignment orders. Also, please indicate date of expected separation from the military
          I am a veteran of the United States Armed Forces who received an honorable discharge within the past 12 months and received my high school education in Maryland.
          Please attach a copy of form DD-214 and documentation of enrollment in a Maryland high school for a minimum of three
          years, and, graduation from Maryland high school or receipt of a GED diploma in Maryland.
          I am eligible for in-state status consideration under the Maryland National Guard Nonresident Tuition Exemption. I am eligible because (1) joined or subsequently served to provide
          a critical military occupational skill or (2) am a member of the Air Force critical specialty code. I understand that I must provide documentation of my eligibility from my Company Commander
          for consideration.

accordance with the University System of Maryland policy on residency. The applicant may be contacted for clarification of an item or for additional information as necessary.

          I am financially independent. I have earned taxable income and I have not been claimed as a dependent on another person’s most recent income tax returns.
          I am financially dependent on another person who has claimed me as a dependent on his/her most recent income tax returns, or I am a ward of the State of Maryland. If a ward of the
          State, please submit documentation and go to item 10.
          Name of person upon whom dependent and relationship to applicant:
          a. How long have you been dependent upon this person?
          b. Is this person a resident of Maryland?         Yes         No
          c. Address of this person:
          d. Length of time at this address:                 years                  months
          e. Is this person a citizen of the United States?          Yes     No     i. If no, type of visa:                                                         ii. Expiration date of visa:
             iii. Alien Registration No.:                                                                                                                           iv. Date of Issuance:
          f. Has this person filed a Maryland state income tax return for the most recent year on all earned income including income earned outside of Maryland?
                 Yes      No If yes, list actual years Maryland income tax returns have been filed within the past three years. i. Years filed:
             ii. If a Maryland tax return has not been filed within the last 12 months, state reason(s):

          g. Signature of this person:

       1. Permanent address:
          Length of time at permanent address                     years                    months
          If less than 12 months, provide previous address:
          Length of time at previous address                    years                   months
       2. Is your primary reason for living in the state of Maryland to attend the university?               Yes    No
       3. Are all or substantially all of your possessions in Maryland?           Yes      No
       4. Do you possess a valid driver’s license?         Yes       No
          a. If yes, initial date of issue                                              b. In what state?
          c. Most recent date of issue                                                  d. In what state?
       5. Do you own any motor vehicles?            Yes    No
          a. If yes, initial date of registration                                       b. In what state?
          c. Most recent date of registration                                           d. In what state?
       6. Are you registered to vote?     Yes     No
          a. If yes, in what state?                                                     b. Date of registration:
          c. Were you previously registered to vote in another state?
       7. Have you filed a Maryland state income tax return for the most recent year? If yes, list years you have filed Maryland income tax returns within the past three years.                   Yes   No
          a. Years filed:                  b. If you did not file a tax return in Maryland within the last 12 months, state reason(s):

       8. Is Maryland state income tax currently being withheld from your pay?                Yes       No    If no, provide explanation:

       9. Do you receive any public assistance from a state or local agency other than one in Maryland?                   Yes     No    a. If yes, please explain

       10. I certify that the information provided is complete and correct. I understand that the university reserves the right to request additional information if necessary. In the event the university
         discovers that false or misleading information has been provided, the student applicant may be billed by the university retroactively to recover the difference between in-state and out-of-
         state tuition for the current and subsequent semesters.

          Signature of applicant                                                                    Signature of parent if applicant is under 18                                        Date



      DATE          JAO            RES          TERM       ADM TYPE          PLAN           ACTION            GPA         RANK              LG     TRANS CRED                          DCF               EVAL


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