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To help us record transcripts of previous academic work, indicate any other names under which you attended another institution. _____________________________________________________________________________________________________________________________________________________________________ List all other postsecondary schools (colleges, universities, nursing schools, etc.) you have attended. School City State # credits earned Dates attended Year graduated __________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ List your school activities, organizations, awards, and work experience, giving details where pertinent, and years of participation. Attach a separate sheet if you need more space. Activity/Organization/Award/Work Experience Description Year(s) __________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ Person to whom bills should be sent__________________________________________________________________________________________________________________________ Name Address City/State/ZIP Family Information Father/Guardian’s Name __________________________________________________ Mother/Guardian’s Name _____________________________________________________ ____________________________________________________________________________________________________ __________________________________________________________________________________________________________ Home address (if different from applicant) Home address (if different from applicant) ____________________________________________________________________________________________________ __________________________________________________________________________________________________________ Occupation/position Occupation/position ____________________________________________________________________________________________________ __________________________________________________________________________________________________________ Name and address of firm Name and address of firm ( )__________________________________________________________________________________________ ( )________________________________________________________________________________________________ Business telephone Business telephone ____________________________________________________________________________________________________ __________________________________________________________________________________________________________ Email address Email address Highest education level attained: Highest education level attained: High school Associate Bachelor’s Master’s Doctorate High school Associate Bachelor’s Master’s Doctorate List relatives who have attended, or been employed by, Marymount University and their relationship to you. Name Relationship Address (city, state) Class year/Employment years __________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ List any other universities or colleges to which you are applying. ___________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________ Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from 9 th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution? Yes No If yes, attach a separate letter of explanation. Have you ever been convicted of a felony or received a verdict of anything other than “not guilty” in any criminal investigation or proceeding? Yes No If yes, describe when the conviction occurred, the facts and circumstances, and facts pertaining to rehabilitation. Do not list any criminal charges for which records have been expunged. A criminal offense will not necessarily bar your admission. Attach separate pages for your response. Please read the following statement and sign below: I understand that withholding information requested in this application or giving false information may make me ineligible for admission to, or continuation at, Marymount University. I certify that the above statements are correct and complete. If I am admitted to Marymount University, I agree to abide by the rules and regulations as stated in the University catalog, student handbook, and other administrative documents and publications. Signature _________________________________________________________________________ Date ________________ Mail this application, along with a nonrefundable $40 fee payable to Marymount University by check (U.S. banks only) or money order, to Marymount University, Admissions Office, 2807 N. Glebe Road, Arlington, VA 22207-4299 Marymount University does not discriminate on the basis of race, color, national origin, sex, age, disability, religion, sexual orientation, or other protected class in any of its educational programs or activities. For inquiries regarding nondiscrimination policies, contact the 504 coordinator, (703) 284-1615, or the Title IX coordinator, (703) 284-1511. The Campus Safety Report, describing campus safety policies and campus crime information, is available upon request.
MARYMOUNT UNIVERSITY Undergraduate Recommendation Applicant: Fill in the shaded section below and give this form to your guidance counselor, dean of students, or — for those applicants who are no longer in school — your employer. (Recommendations from family members cannot be accepted.) Ask the recommender to answer the questions, sign the form, and send it to Admissions Office, Marymount University, 2807 N. Glebe Road, Arlington, VA 22207-4299. Questions may be directed to (703) 284-1500 or (800) 548-7638. MU Student ID or Last 4 digits of Social Security Number ___________ Name ___________________________________________________________________________________________________________________________________________________ Last First Middle Maiden Permanent home address _____________________________________________________________________________________________________________________________ Number and street _______________________________________________________________________________ Permanent home telephone ( City State ZIP Country I do not waive the right of access to this form. I waive the right of access to this form. ) ___________________________________ Signature _______________________________________________________________________________________________________________________________________________ The following questions are to be answered by the person recommending the applicant. Attach a separate sheet of paper if you need more space. 1. How long and in what capacity have you known the applicant? ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________ 2. What are the applicant’s outstanding personal and/or academic characteristics? ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________ 3. Does the applicant have any limitations that may require special consideration to help his/her adjustment to college life? ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________ EMPLOYERS: Please proceed to question #9. All others should continue to question #4. 4. What is the applicant’s current status at your school? Enrolled (beginning: _________/_________) Suspended (date: _________/_________) mo yr mo yr Withdrawn (date: _________/_________) Graduated (date: _________/_________) mo yr mo yr 5. Has this student been on academic probation? Yes (please explain) No ___________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________
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