Martin University

Becoming a Student

Undergraduate Admissions Form

Student Status (Select One)

New Student (Never attended college)
Re-entry Martin Student / Last year attended:
Transfer New Student (Previously attended a college)
Non-degree

Personal Information

First Name:
Middle Name:
Last Name:
Maiden Name:

Gender: Male Female

Address

Street:
Apt. #:
City:
State:
Zip:
Country:

Phone (Beginning With Area Code)

Home:
Work:
Cell:

Email

Email:

Background

Marital status

Single
Married
Divorced
Widowed
Seperated

Other

Birth Date:
Head of Household: Yes No
Number of Dependents:

Ethnic Data

American Indian
African American
Hispanic
Alaskan Native
Asian/Pacific Islander
Caucasian
Nonresident Alien
Other

Nationality

Are you a U.S. citizen? Yes No

Country of origin:
Permanent resident alien number:

Veteran Status

U.S. Veteran
Non-Veteran

Emergency Contact

Name:
Address:
Phone:

Current Employer

Are you currently employed: Yes No

Name:
Address:
Phone:
Length of Employment:

Education

Intended Semester Entry Date:
Fall
Winter
Summer

Year:

High School

High school graduate? Yes No

Date Graduated:
Highschool name:
Highschool Street:
Highschool City:
Highschool State:
Highschool Zip:
Highschool Country:

GED completed: Yes No

Date Completed: GED Site name:
GED Site Street:
GED Site City:
GED Site State:
GED Site Zip:
GED Site Country:

College

List college(s)/ universities you have attended:

1.

Name:
City:
State:
Country:
Year Graduated:

2.

Name:
City:
State:
Country:
Year Graduated:

3.

Name:
City:
State:
Country:
Year Graduated:

Did you graduate? Yes No

Degrees Earned:

Year:

Does your father have a college degree? Yes No
Does your mother have a college degree? Yes No

Are you transferring from another college/university? Yes No
Do you intend to obtain a degree at Martin University? Yes No

If no, please explain:

Date of intended graduation:
Major:
Minor:

Reason for Attending

Write a paragraph stating why you wish to attend Martin University. Please include any factors that might hinder you from attending classes such as health problems, employment, and/or transportaion problems.

Do you need any special accommodations?

All the information above is accurately and honestly presented. You must check the box above!

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