NORTH CAROLINA STATE UNIVERSITY

APPLICATION FOR UNDERGRADUATE ADMISSION

NATIONAL STUDENT EXCHANGE

This form should only be completed by incoming students who have already received notice of acceptance from their home campus.

 

Abbreviate as appropriate, using standard postal regulations for abbreviations of states in the address.

PERSONAL INFORMATION:

 

Name:   Last:    First:  Middle:

 

Social Security Number: xxx-xx-xxxx  Name you prefer to be called:

 

Date of Birth: xx-xx-xx      Sex:   Female     Male    Marital Status:  Single   Married

 

Ethnic Identification is required by the Office of Civil Rights of the Department of Education to assure compliance with the Civil Rights Act.  Ethnic origin is not a factor in admission; all applications are considered without reference to sex, creed, or race.

 

African-American (Not of Hispanic Origin): Origin in any of the black racial groups of Africa.

 

Asian or Pacific Islander: Origin in any of the original peoples of the Far East, Southeast Asia or the Pacific Islands.

 

Hispanic: Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

 

   Native American: Origin in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.

 

White (Not of Hispanic origin): Origin in any of the original peoples of Europe, North Africa, or the Middle East.

 

Mailing Address:    Number and Street:

City:    County:     State:    Zip Code:

 

Phone: (xxx)xxx-xxxx    Fax: (xxx)xxx-xxxx  Email:

 

Place of Birth:    City:     County or Province:   

State (or country if not in the U.S.) :

 

Country of Citizenship:

US Citizen    Permanent Resident (Resident alien# , Date issued: )

 

Non-US Citizen, indicate country  (Visa type: Date issued )

 

 

ACADEMIC MAJOR:

Indicate below the NC State College/School and major to which you wish to be admitted.  See http://www.ncsu.edu/registrar/publications/pdf/undergradcurricula.pdf for a list of majors and curriculum codes.  Your application cannot be processed without this information.

 

College/School:            Curriculum Code:

 

 

DATE OF ENTRANCE:

Fall Spring  Session 1 (Summer School)  Session 2 (Summer School) Calendar Year:

 

 

HIGH SCHOOL INFORMATION:

Last High School Attended:    Location:

 

COLLEGE INFORMATION:

Are you currently enrolled in college? Yes  No

 

List all colleges you have attended.  List the most recently attended first and indicate expected dates of attendance if currently enrolled.  Failure to furnish full information may bar admission or result in cancellation of registration.

 

You must have an official transcript sent from each college attended after completion of coursework.

 

Current/Last College Attended:     Address:    City:   State:

(Dates of Attendance) From: xx-xx  Until: xx-xx     

Degree received or anticipated: Yes   No    (e.g. AA, AS, BA, etc)

 

 

College Attended: Address:   City:   State:

(Dates of Attendance) From: xx-xx  Until: xx-xx     

Degree received or anticipated: Yes   No    (e.g. AA AS, BA, etc)

 

Additional Colleges Attended:

 

Please list current courses in progress:

Course Title:                   Date Courses will End:                  Credit:

                                   

                                   

                                   

                                   

                                   

                                   

                                   

 

 

 

PARENTS: (OPTIONAL)

Father: Living    Deceased                      Name:        Phone Number:

Mother: Living    Deceased                     Name:        Phone Number:

 

Are either of your parents alumni of North Carolina State University?

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Father: Yes    No                       Mother: Yes               No

 

If any of your other relatives are alumni of NC State University, please list their names and relationship to you.

 

OTHER INFORMATION:

Have you been convicted of a criminal offense other than a minor traffic violation? Yes   No

Are there such criminal charges pending against you at this time?  Yes    No

Have you ever been dismissed, suspended, or placed on probation by ANY school?  Yes     No

(If you answered yes to any of the three questions above, please explain these circumstances below.)

 

 

 

 

LEGAL RESIDENCY:

Are you a legal resident of N.C.?  Yes    No

 

CANDIDATES SUPPLEMENTAL INFORMATION:

Please tell us more about you.  We would like to know more about you than just your academic record.

Thank you!

 

I certify that all the information given on this application is correct.  I agree to allow the university to share information on the status of my application with my home campus.  I hereby acknowledge that completion of item 1 (social security number) is voluntary, is requested by the institution solely for administrative convenience and record-keeping accuracy, and is requested only to provide a personal identifier for the internal records of this institution.  I pledge that I will adhere to the NC State Code of Student Conduct, and that I will uphold the highest level of academic integrity by not participating in any form of academic misconduct.

Yes            No

 

 

 

 

If you do not wish to submit the application online, you may print and send the completed application to:

          N. Alexander Miller III                             Or                Christy Rain

          NSE Coordinator                                                        Assistant Coordinator

          4130 Talley Student Center/Campus Box 7306                4130 Talley Student Center/Campus Box 7306

          Raleigh, NC 27695-7306                                              Raleigh, NC 27695-7306

 

                                      Or you may fax the completed application to 919-515-5280.