TSU Distance Learning Graduate Admissions Form

TSU Distance Learning Graduate Application for Admission

IMPORTANT NOTICE!

You are about to submit your Application for Graduate Admission to the Distance Learning Center at Troy State University for PROCESSING. Your application WILL NOT be processed until receipt of the $40 application fee. Payments NOT made by credit card, may be made directly to the Distance Learning Center by check or money order ONLY.

The Application and application fee MUST be received in the Distance Learning Center NO LATER than close of business on Friday, May 7, 2004, in order to Register for Term 5, 2004 (May 24 - August 1, 2004) courses. Any Application and/or application fee received after 5:00 p.m. CST on May 7, 2004 will be processed for Term 1, 2004, for the 2004-2005 academic year.

Term you wish to enter:
Academic Level:
Status:

Indicate "Transient" if you are a graduate student enrolled at another university other than Troy State, and select "Transient" in all other applicable areas for proposed major/course of study.
If Transient, list name of graduate school:
If you are a Transfer Student from another regionally accredited graduate school, list name of graduate school:

Applicant's First Name:		M.I.:
Applicant's Last Name:		Suffix:

Previous Last Name(s) Listed on Transcripts:
Social Security Number:		e-mail:

Primary Telephone:		Ext:
Secondary Telephone:		Ext:

Mailing Address:

Street Address:
Street Address:

City:

State:

Zip:

County:

Country:

Permanent Address (if different from above):

Street Address:
Street Address:

City:

State:

Zip:

County:

Country:

Date of Birth:

Gender:

Male Female

Marital Status:

Country of Citizenship:

Ethnic Origin*:
*Note: This information is voluntary and will not be used in any discriminatory manner.

Highest Degree Completed:		Date Completed:
Institution:

Proposed Masters:
Concentration:
Anticipated Date of Completion:
Financial Aid Intent:

Have you taken:

	GRE		MAT		GMAT
	TOEFL (International Students Only)		None Taken (GRE, GMAT or MAT required for admission)

Have you previously applied to the TSU system?	Yes No
If so, which Region/Campus?
If you previously applied, did you attend?	Yes No

List ALL educational institutions attended. Failure to report ALL institutions may result in dismissal.

Name of Institution	City & State	Type of Degree	Dates Attended MM/YYYY to MM/YYYY

TSU MUST receive all official transcripts for each institution of higher learning which you have attended.

Are you currently enrolled in the last institution attended?	Yes No
If yes, what will be your last date of attendance?	(MM/DD/YYYY)
Are you eligible for readmission to the college from which you are transferring?	Yes No
Note: A student on Temporary, Indefinite, Permanent or Academic suspension from another college or university is eligible to apply for admission to TSU after serving the suspension from the previous institution.
If no, are the reasons disciplinary or academic?	Disciplinary Academic
Have you been disciplined for an infraction of college or university standards?	Yes No If yes, explain in field below:
Note: Students on disciplinary suspension from another institution must be eligible to return to that institution before being considered for admission to TSU. Requests for waiver must be submitted in writing to the Dean of Graduate Studies and Research.

Are you a veteran?	Yes No
Have you ever been convicted of a Federal, State, County, or Municipality law?	Yes No If yes, explain in field below:

I hereby affirm that the information supplied in the blanks is complete and accurate. I understand that withholding information requested or giving false information may make me ineligible for admissions and enrollment.
Accept
There is a $40 processing fee for all NEW Graduate Admission Applications. Please choose payment method:

If you chose Personal Check or Money Order:

BEFORE clicking the submit button, please print out a copy of this application, mail the printed application and your Personal Check or Money Order to:

TSU Distance Learning
Graduate Admissions
304 Wallace Hall
Troy State University
Troy, AL 36082

If you chose Online Secure Credit Card Payment:

AFTER clicking the submit button, please proceed to the secure online Credit Card Authorization page. You may access the credit card form page by clicking on the "Online Forms" section of the www.tsulearn.net website.

When you have completed all sections of this form, and have read information regarding payment of the application processing fee, please click "Submit" to have your application electronically sent to the Distance Learning Graduate Admissions Department.