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download a PDF application - Marymount University

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MARYMOUNT UNIVERSITY<br />

Undergraduate Application<br />

Office of Admissions · 2807 North Glebe Road, Arlington, Virginia 22207-4299 · Phone: (703) 284-1500 · Fax: (703) 522-0349<br />

Complete this <strong>application</strong>, or apply online at www.marymount.edu/apply<br />

APPLICANT INFORMATION<br />

Mr. Mrs. Ms. Miss Dr.<br />

Date _________________________<br />

Name ______________________________________________________________________________________________________________________________________________________________<br />

Last/Family/Surname First/Given/Personal Middle Maiden<br />

PERMANENT HOME ADDRESS<br />

CURRENT ADDRESS (IF DIFFERENT FROM PERMANENT ADDRESS)<br />

________________________________________________________________________________ __________________________________________________________________________________<br />

Number and Street Apt. Number and Street Apt.<br />

________________________________________________________________________________ __________________________________________________________________________________<br />

City State ZIP Country City State ZIP Country<br />

( ) _________________________ ( ) _________________________ ( ) _________________________<br />

Phone Cell Phone<br />

Email _________________________________________________________________________<br />

Social Security #________________________________________________________________<br />

Male Female Birthdate ___________________________________________ Birthplace_______________________________________________________________________<br />

Religion (optional)___________________________________________________________ Is English your first language? Yes No<br />

Please send all correspondence to my permanent address my current address (valid until ____________)<br />

Are you a U.S. citizen? Yes No (If no, please complete the shaded section below.)<br />

What is your country of citizenship?_______________________________<br />

Are you a U.S. permanent resident? Yes No<br />

If yes, please include a photocopy of your Green Card with your completed <strong>application</strong>.<br />

If no, what is your visa type?_____________________________________<br />

Have you previously applied to <strong>Marymount</strong> <strong>University</strong>? No Yes Application date _____________________________<br />

Have you previously attended <strong>Marymount</strong> <strong>University</strong>? No Yes From ___________ to ____________ Student Number____________________________<br />

We request the following information in compliance with Title VI of the Civil Rights Act. Your response is voluntary and has no bearing on the<br />

admission decision:<br />

Ethnicity: Hispanic/Latino Non-Hispanic/Latino<br />

Race (please check all that apply): American Indian, Alaska Native Asian Black, African American<br />

Hawaiian or other Pacific Islander White<br />

ENROLLMENT INFORMATION<br />

Semester/year you plan to enroll Fall 20______ Spring 20______<br />

Attendance status Full time (12 credits or more) Part time (under 12 credits)<br />

Residence status (See Residence Requirement on page 1) Residence hall student Commuter student (local area)<br />

Major (see inside back cover) ______________________________________________<br />

Minor (optional) ______________________________________________________________<br />

Please indicate if you have an educational goal in one of the following areas of interest. (This information is used for academic advising only.)<br />

Education/Teaching Licensure Pre-Law Pre-Medicine Pre-Physical Therapy<br />

Do you intend to apply for financial aid? Yes No<br />

ACADEMIC INFORMATION<br />

List all high schools you have attended. Attach a separate sheet if you need more space.<br />

School City State CEEB code (if known) Dates attended Year graduated<br />

_____________________________________________________________________________________________________________________________________________________________________<br />

_____________________________________________________________________________________________________________________________________________________________________<br />

Name of high school/college guidance counselor ________________________________________________________ Phone (<br />

List dates you have taken — or will be taking — the SAT, ACT, TOEFL, IELTS, or PTE exam.<br />

SAT Date(s) ____________________________________________<br />

If you are not a U.S. citizen or permanent resident,<br />

please complete the required International Student Supplemental<br />

Information (ISSI) form. Download the form at www.marymount.<br />

edu/admissions/international<br />

ACT Date(s) ____________________________________________<br />

TOEFL Date(s) _____________________ IELTS Date(s)_____________________ PTE Date(s)_____________________<br />

)_______________________________________

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