4-year college degree. â¡ Postgraduate study. Occupation: PARENT / LEGAL GUARDIAN Circle one: Ms. Mrs. Mr. Dr. 27. Name
INSTRUCTIONS:
1. Use an ink pen and print legibly. 2. Sign and date application in section #46. 3. Attach non-refundable $50 application fee and mail to: Office of Admissions, 2700 Evergreen Pkwy NW, Olympia, WA 98505-0002. 4. Request official transcripts mailed from all schools, colleges, and universities attended. These documents should be directed to the Office of Admissions. 5. To request disability accommodation in the application process, contact: Office of Admissions at (360) 867-6170 or
[email protected].
UNDERGRADUATE APPLICATION o Freshman Student
1.
I am applying as:
2.
I am applying to the campus in:
3.
I am applying for:
o Transfer Student
o Olympia (lower- and upper-division students) o Tacoma (upper-division only) o Tribal Site (upper-division only)
o Fall ________ o Winter ________ o Spring ________Check one quarter only. Year
Year
4.
I have previously applied for admission at Evergreen:
5.
I have previously attended Evergreen:
o Returning Evergreen Student o Post-Baccalaureate
Year
o No
o Yes: ______________ Quarter/Year
o No o Yes: Dates of Attendance
6.
I am a resident of Washington state:
o
o
No
Yes: From
7.
Intended area of interest: First choice:
8.
I plan to attend during evenings and weekends only:
to
Month/Year
to
Year
Month /Year
Year
(If yes, you must include dates of your most recent continuous residence in Washington.)
Second choice:
o No o Yes
PERSONAL DATA 9.
o Male o Female
10. Social Security Number (If applicable) By law, providing your Social Security Number is optional. Providing your SSN will assist in the processing of your admission and
financial aid applications. It may also be used for educational research purposes. Releasing student information will be in accordance with all appropriate state and federal laws. The SSN is not used as the primary student ID at Evergreen.
11. Legal
Name
Chosen First Name
Family or Surname
First or Given
Middle
Jr., etc.
12. Former
Name(s): If your first or last name has changed, indicate your former full name(s).
Family
13.
First or Given
Middle
Jr., etc.
Mailing Address
Family
First or Given
Middle
Jr., etc.
Number and Street
Apt.
City
State/Province Zip/ Postal Code
Country
Please Note: All admissions correspondence will be mailed to the Mailing Address (#13), not the Permanent Mailing Address (#15). Please notify the Office of Admissions two weeks prior for a change of Mailing Address. 14.
E-mail Address (optional)
15.
Permanent Mailing Address (if different from above)
Number and Street
Apt.
City
State/Province Zip/Postal Code
16a. Telephone
16b. Mobile
17. Date
of Birth
20. What
of citizenship
o
U.S.A. (skip to #22)
o Yes, I will accept text messages to my mobile phone.
Birthplace
Month/Day/Year
19. Country
o
City and State/Province OR Country if other than U.S.
Other
is your country of permanent residence?
21. Current 22. Are
18.
Country
U.S. visa type (Specify country)
you a U.S. military veteran?
o
Date visa granted Yes
o
No
1
HISPANIC ORIGIN AND RACIAL IDENTITY (OPTIONAL) Evergreen is required to ask all applicants to provide a response in these two sections. Your response(s) are optional. If you answer: “No, I am non-Hispanic in origin” please consider indicating your race in the Racial Identity section. You may make more than one selection from those provided in the American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander and White subsections. And, where applicable, you may select “Other” and specify your race.
HISPANIC ORIGIN (optional) 23.
Are you Hispanic in origin?
o No, I am non-Hispanic in origin. o Yes, I am Hispanic in origin. (select one or more) o Argentinian o Bolivian o Chilean o Colombian o Costa Rican
o Cuban o Dominican o Ecuatorian
(Ecuadorian)
o Guatemalan o Honduran o Mexican or
Mexican-American (Chicano)
o Nicaraguan o Panamanian o Peruvian
o Puerto Rican o Salvadoran o Spanish
o Uruguayan o Venezuelan
o Other Hispanic Origin _________________________________________ Please specify
RACIAL IDENTITY (optional) 24. How
do you describe your race? (select one or more)
o American Indian or Alaska Native American Indian (select one or more)
o Chehalis o Chinook o Colville o Cowlitz o Duwamish o Hoh o Jamestown o Kalispel o Kikiallus
o Lower Elwha o Lummi o Makah o Muckleshoot o Nisqually o Nooksack o Port Gamble Klallam o Puyallup o Quileute
Alaska Native (select one or more)
o Quinault o Samish o Sauk-Suiattle o Shoalwater o Skokomish o Snohomish o Snoqualmie o Snoqualmoo o Spokane
o Squaxin Island o Steilacoom o Stillaguamish o Suquamish o Swinomish o Tulalip o Upper Skagit o Yakama
o Alaska Aleut
o Maldivian o Mongolian o Nepali
o Pakistani o Singaporean o Sri Lankan
(Unangan)
o Alaska Alutiq o Alaska Athabaskan o Alaska Eskimo
o Alaska Eyak o Alaska Haida o Alaska Tlingit o Alaska Tsimshian
(Inupiaq or Yupik)
o Other Alaska Native _________________________________________ Please specify
o Other American Indian ______________________________________ Please specify
o Asian (select one or more) o Asian Indian o Chinese o Bangladeshi o Filipino Bhutanese o o Hmong o Burmese o Indonesian o Cambodian (Kampuchean)
o Japanese o Korean o Laotian o Madagascar o Malayan
o Taiwanese o Thai o Vietnamese
o Other Asian __________________________________________________ Please specify
o Black or African American o Native Hawaiian or Other Pacific Islander (select one or more) o Fijian o Guamanian o Kosraean o Mariana Islander
o Marshall Islander o Micronesian o Native Hawaiian o Palauan
o Papua New Guinean o Solomon Islander o Tokelauan o Vanuatuan (New Hebrides Islander) o Ponapean o Tahitian o Tongan (Pohnpeian) o Tarawa Islander o Trukese (Chuukese) o Yapese o Samoan o Other Pacific Islander _________________________________________ Please specify
o White (includes people of European, Middle Eastern, or North African descent) o Other _________________________________________ 2
FAMILY INFORMATION Evergreen is interested in collecting accurate information about your parents, including their education and employment. Your answers will be used to support Washington state and federal government programs to address the needs of college students. You are encouraged to complete this section of the application even if you are no longer a dependent. PARENT / LEGAL GUARDIAN 25.
Circle one:
Ms.
Mrs.
Mr.
Dr.
Name
Is s/he living? Family or Surname
First or Given
Telephone
o Yes o No (skip to #26)
E-mail Address (optional)
Mailing Address
Number and Street
Apt.
26.
Parent or guardian’s highest level of formal education completed:
City
State/Province Zip/Postal Code Country
o Some high school o 2-yr. college degree
o HS graduate o 4-year college degree
o Some college o Postgraduate study
Occupation: PARENT / LEGAL GUARDIAN 27.
Circle one:
Ms.
Mrs.
Mr.
Dr.
Name
Is s/he living? Family or Surname
First or Given
Telephone
o Yes o No (skip to #28)
E-mail Address (optional)
Mailing Address
Number and Street
City
28.
Apt.
State/Province Zip/Postal Code Country
Parent or guardian’s highest level of formal education completed:
o Some high school o 2-yr. college degree
o HS graduate o 4-year college degree
o Some college o Postgraduate study
Occupation: Do you have a relative who graduated from Evergreen?
o No o Yes
Relationship:_______________________________________
FORMER FOSTER CARE YOUTH Scholarship and financial aid grant opportunities are available for former foster care youth. The Washington State Governors’ Scholarship for Foster Youth and Passport for Foster Youth Promise scholarship program encourages foster care youth to prepare for and succeed in college. Your answer to question 29 may allow Evergreen to see if you qualify for financial aid grants. 29.
Were you a former foster care youth in Washington state?
o No o Yes
More information about these programs is available online: Washington State Governors’ Scholarship for Foster Youth - CollegeSuccessFoundation.org/wa/scholarships/governors Passport for Foster Youth Promise - wsac.wa.gov/passport-foster-youth
EDUCATIONAL BACKGROUND AND OBJECTIVES 30.
List all high schools attended during grades 9 through 12, beginning with the most recent:
High School
City
State/Country
Grade Level
31. Have 32. Did
you take the G.E.D. test?
33. Have 34. At
o No
you graduated or will you graduate from high school?
o No
o Yes:
you ever attended school outside the U.S.?
what level did you begin school in the U.S.?
35. Before
Year Taken
o Yes
o K-7
o Yes: ______________________ (skip to #33) Month / Year of Graduation
o No (If no, Freshman Applicants, skip to #36. Transfer Applicants, skip to #40) o 8 o 9-12 o College or university o No school in U.S.
coming to the U.S., what language was used for instruction in your school(s)? 3
ADMISSIONS TESTS ACT or SAT test scores are required for all freshman applicants who are 24 years of age or younger and from transfer students with fewer than 40 transferable quarter credits earned at the time of application. This test score requirement includes freshman applicants who have earned, or will earn, college credit prior to graduating from high school. You must arrange to have official scores sent directly from the testing agency or by your high school guidance office. Test of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS) are required of all international applicants for whom English is not the primary language used for instruction. You must arrange to have official scores sent directly from TOEFL or IELTS to The Evergreen State College.
FRESHMEN FROM HIGH SCHOOL ONLY Complete this section regardless of the number of college credits earned before high school graduation. 36. Senior
Year Courses List all the high school and college credit courses you are taking and plan to take in your senior year (grade 12) and in the summer before you enroll at Evergreen. Notify the Admissions Office of any changes. Misrepresenting your schedule and/or failure to complete courses listed may jeopardize your admission status. For each term, write the course title(s) and number of credits (usually, 1 credit = 1 full year; 1/2 credit = 1 semester; 1/3 credit = 1 trimester).
Earning college credit during your senior year in high school? Write the course name, course number, and credits in the table. Example: “English 101, 5 credits.”
TERM 1 Check box:
o
o
Sem. 1
Qtr. 1
Course Title
TERM 2
o
Other
Credits
o Sem. 2
o Qtr. 2
TERM 3
o Other o Qtr. 3
Course Title
Credits
o Summer
Course Title
o Other Credits
English
Mathematics
Science
Social Science Foreign Language Fine/Performing Arts Other
o No o Yes: Credits earned
37.
Did you earn college credit during your junior year in high school?
Name of the high school-college program? For example: Running Start, Washington
Name(s) of college(s) attended?
38.
How many college credits do you expect to earn during your senior year in high school?
Name of the high school-college program? For example: Running Start, Washington
Name(s) of college(s) attended?
39. Do
you plan to take other courses for college credit after high school graduation, but before enrolling at Evergreen?
Yes – complete sections 40 and 45 on the back page. o No (skip to #46) o
Official college transcripts are required for transfer credit to be awarded by Evergreen. APPLICANT: Your application is complete only if you sign and date the application in #46.
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YOUR APPLICATION STATEMENT Your statement will help the Admissions Committee learn more about you and your interest in Evergreen. Submission of the statement is optional for most applicants. Freshman applicants who are 25 years old or older, who do not have SAT or ACT test scores are required to submit an Application Statement and résumé. Please answer the following question: What experiences (academic, service, or professional) have prepared you for college studies at Evergreen?
Guidelines for your application statement 1.
Your typewritten statement should be 300-500 words in length.
2.
Put your full legal name and your date of birth on all pages of your statement and résumé.
3.
Enclose your statement with your application.
5
APPLICANTS WITH COLLEGE CREDIT earned after high school graduation 40. List
in order of attendance and have all official transcripts sent from all colleges or universities you have ever attended or will attend before enrollment at Evergreen. Do not exclude or omit any colleges, regardless of how many credits you earned there or the nature of the program in which you were enrolled. Location
Name of College/University
Dates of Attendance
City/State
(Month/Year)
(Month/Year)
to to to to to to 41. Will
you be a Washington resident transferring from a Washington community college with an academic associate degree,
or Direct Transfer Agreement?
42. Have
o No o Yes
you earned a degree (AA, AA&S, BA, BS, etc.)?
1. College
o No o Yes (please indicate at right)
Name of Degree
Date of Degree
Name of Degree
Expected Date of Degree
2. 43. Do
you expect to earn a degree before entering Evergreen?
44. Are
45.
you currently or will you be enrolled in a college or university prior to entering Evergreen?
o No o Yes:
o No o Yes:
Name of College/University
List all courses you are taking or plan to take between now and when you enter Evergreen. Course #
Short Course Title
Term/Year
Credits
SIGNATURE 46.
In signing this form, I acknowledge that failure to disclose and submit official transcripts from all schools, colleges, or universities attended and failure to disclose and submit complete and accurate information may result in the denial of admission or subsequent dismissal from said institution. I certify that to the best of my knowledge statements I have made in this application are complete and true. I hereby give permission to release appropriate test scores and academic records requested by said university or college. I understand that my application is incomplete without my signature below.
Signature of Applicant
Date
Washington baccalaureate colleges and universities provide equal opportunity in education without regard to race, color, creed, religion, national origin, gender, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam-era veteran in accordance with institutional policies and applicable federal and state statutes and regulations. UG 10.14
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