NSE Application

*First Name:

Middle Initial:

*Last Name:

*Current Address:

(Please include a full address with state or province as well as zip or postal code.)

Permanent Address:

(Please include a full address with state or province as well as zip or postal code.)

Current Phone:

Permanent Phone:

Alternate Phone:

*E-mail:

Alternate E-mail:

*Student ID:

*Date of Birth:

Gender:
Male
Female

Home Campus State Resident:
Yes
No

Currently Living on Home Campus:
Yes
No

U.S. Citizenship:
Select Yes No. Have F-1 Visa No. Have J-1 Visa No. Have no VIsa Resident Alien

Canadian Citizenship:
Yes
No

Motive for Participation:
Access different courses/faculty
Evaluate graduate schools
Live in a different area
Personal growth
Participate in host's international program
Enter host's honors program
Exchange as a resident assistant
Language Study
Look for future employment
Other

If other, please specify in the following space:

Current Class Level:
Select Freshman Sophomore Junior Senior

*GPA: (on a 4.0 scale):

Major:

Minor:

Need Major Classes:
Yes
No

Requesting Financial Aid From Host Campus:
Yes
No

Received Financial Aid This Term:
Yes
No

Want on-campus Housing:
Yes
No

First Time Placement:
Yes
No

Enrolled in Home Campus Honors Program:
Yes
No

Marital Status:
Single
Married

Will you be accompanied by spouse?:
Yes
No

Will you be accompanied by children?:
Yes
No

Do you wish to go on exchange with another student?:
Yes
No

If yes, name of the student?:

Name of campus at which the student is enrolled?

*School Choice 1:
School 1 Alabama A & M University | A or B Alabama State University | A or B Arkansas State University | A or B Ball State University | Plan B Binghamton University | A or B Bishop's University | Plan B Boise State University | A or B Bowie State University | Plan B Bowling Green State University | A or B Bridgewater State College | A or B California Polytechnic State U, San Luis Obispo | A or B California State Polytechnic University, Pomona | A or B California State University, Bakersfield | A or B California State University, Chico | A or B California State University, Fresno | A or B California State University, Hayward | A or B California State University, Los Angeles | A or B California State University, Monterey Bay | Plan B California State University, Northridge | A or B California State University, San Bernardino | A or B California University of Pennsylvania | A or B Central Washington University | A or B Cleveland State University | A or B College of Charleston | Plan B East Central University | A or B East Stroudsburg University of Pennsylvania | A or B East Tennessee State University | A or B Eastern Connecticut State University | Plan B Eastern New Mexico University | Plan B Eastern Oregon University | A or B Fairmont State College | A or B Ferris State University | A or B Florida International University | A or B Fort Hays State University | Plan B Framingham State College | Plan B George Mason University | No Plan Grambling State University | A or B Howard University | Plan B Humboldt State University | A or B Hunter College, City University of New York | A or B Idaho State University | A or B Illinois State University | A or B Indiana University of Pennsylvania | A or B Indiana University-Purdue University Fort Wayne | Plan B Inter American Univ of Puerto Rico-San German | A or B Iowa State University | A or B Johnson State College | A or B Keene State College | Plan B Kent State University | A or B Kutztown University of Pennsylvania | No Plan Louisiana State University | A or B Marshall University | Plan B Mesa State College | A or B Michigan Technological University | Plan B Minnesota State University Moorhead | A or B Minnesota State University, Mankato | Plan B Mississippi State University | Plan B Montana State University | A or B Morehead State University | Plan B Murray State University | A or B NC State University | A or B New College of Florida | Plan B New Mexico Institute of Mining and Technology | Plan B New Mexico State University | Plan B North Carolina Central University | A or B Northeastern Illinois University | A or B Northern Arizona University | A or B Northern State University | Plan B Oklahoma State University | A or B Oregon State University | A or B Plattsburgh State University of New York | A or B Plymouth State University | Plan B Ramapo College of New Jersey | A or B Rhode Island College | Plan B Rutgers College, Rutgers University | Plan A San Jose State University | A or B Simon Fraser University | A or B Sir Wilfred Grenfell College | Plan B Sonoma State University | A or B South Carolina State University | Plan B South Dakota State University | A or B Southern Oregon University | A or B Southern University | A or B Southern Utah University | No Plan Southern Utah University | A or B Southwest Missouri State University | A or B St. Mary's College of Maryland | Plan B Stony Brook University | A or B SUNY College at Buffalo | A or B SUNY College at Potsdam | A or B Tennessee State University | A or B Texas State University-San Marcos | A or B The College of New Jersey | A or B Towson University | Plan B Tuskegee University | Plan B Universidad del Sagrado Corazon | A or B Universite de Sherbrooke | Plan B University College of Cape Breton | A or B University of Alabama | A or B University of Alaska Anchorage | A or B University of Alaska Fairbanks | A or B University of Alaska Southeast | A or B University of Arizona | Plan B University of Central Florida | Plan B University of Connecticut | Plan B University of Georgia | Plan B University of Guam | A or B University of Hawaii at Hilo | A or B University of Hawaii at Manoa | A or B University of Idaho | A or B University of Kentucky | Plan B University of Louisville | Plan B University of Maine | A or B University of Maine at Farmington | Plan B University of Maine at Presque Isle | A or B University of Maryland at College Park | Plan B University of Massachusetts at Amherst | A or B University of Massachusetts at Boston | A or B University of Memphis | A or B University of Minnesota, Morris | A or B University of Minnesota, Twin Cities | Plan A University of Mississippi | Plan B University of Missouri-St. Louis | A or B University of Montana | A or B University of Nebraska at Kearney | A or B University of Nevada, Las Vegas | A or B University of Nevada, Reno | A or B University of New Hampshire | Plan B University of New Mexico | Plan B University of New Orleans | A or B University of North Carolina at Asheville | Plan B University of North Carolina at Wilmington | Plan B University of North Texas | A or B University of Northern British Columbia | A or B University of Northern Colorado | Plan B University of Northern Iowa | Plan B University of Oregon | A or B University of Puerto Rico, Bayamon | A or B University of Puerto Rico, Cayey | A or B University of Puerto Rico, Humacao | A or B University of Puerto Rico, Mayaguez | A or B University of Puerto Rico, Rio Piedras | A or B University of Regina | A or B University of Rhode Island | A or B University of South Carolina | Plan B University of South Dakota | A or B University of South Florida | A or B University of Southern Maine | A or B University of Tennessee | A or B University of Tennessee at Chattanooga | A or B University of Texas at El Paso | A or B University of Texas at San Antonio | A or B University of the Virgin Islands, St. Croix | A or B University of the Virgin Islands, St. Thomas | A or B University of Utah | A or B University of Washington | A or B University of West Florida | Plan B University of Wisconsin-Eau Claire | Plan B University of Wisconsin-Green Bay | Plan B University of Wisconsin-Platteville | Plan B University of Wisconsin-River Falls | Plan B University of Wisconsin-Whitewater | Plan B University of Wyoming | A or B Utah State University | A or B Virginia Commonwealth University | Plan B Washington State University | Plan B Wesleyan College | Plan B West Chester University of Pennsylvania | A or B West Virginia University | A or B Western Carolina University | Plan B Western State College of Colorado | A or B Western Washington University | A or B Westfield State College | A or B Wichita State University | Plan B Winthrop University | Plan B
*School Choice 1 Plan:
Plan A Plan B A or B Prefer A Prefer B

*Schools Choice 2:
School 2 Alabama A & M University | A or B Alabama State University | A or B Arkansas State University | A or B Ball State University | Plan B Binghamton University | A or B Bishop's University | Plan B Boise State University | A or B Bowie State University | Plan B Bowling Green State University | A or B Bridgewater State College | A or B California Polytechnic State U, San Luis Obispo | A or B California State Polytechnic University, Pomona | A or B California State University, Bakersfield | A or B California State University, Chico | A or B California State University, Fresno | A or B California State University, Hayward | A or B California State University, Los Angeles | A or B California State University, Monterey Bay | Plan B California State University, Northridge | A or B California State University, San Bernardino | A or B California University of Pennsylvania | A or B Central Washington University | A or B Cleveland State University | A or B College of Charleston | Plan B East Central University | A or B East Stroudsburg University of Pennsylvania | A or B East Tennessee State University | A or B Eastern Connecticut State University | Plan B Eastern New Mexico University | Plan B Eastern Oregon University | A or B Fairmont State College | A or B Ferris State University | A or B Florida International University | A or B Fort Hays State University | Plan B Framingham State College | Plan B George Mason University | No Plan Grambling State University | A or B Howard University | Plan B Humboldt State University | A or B Hunter College, City University of New York | A or B Idaho State University | A or B Illinois State University | A or B Indiana University of Pennsylvania | A or B Indiana University-Purdue University Fort Wayne | Plan B Inter American Univ of Puerto Rico-San German | A or B Iowa State University | A or B Johnson State College | A or B Keene State College | Plan B Kent State University | A or B Kutztown University of Pennsylvania | No Plan Louisiana State University | A or B Marshall University | Plan B Mesa State College | A or B Michigan Technological University | Plan B Minnesota State University Moorhead | A or B Minnesota State University, Mankato | Plan B Mississippi State University | Plan B Montana State University | A or B Morehead State University | Plan B Murray State University | A or B NC State University | A or B New College of Florida | Plan B New Mexico Institute of Mining and Technology | Plan B New Mexico State University | Plan B North Carolina Central University | A or B Northeastern Illinois University | A or B Northern Arizona University | A or B Northern State University | Plan B Oklahoma State University | A or B Oregon State University | A or B Plattsburgh State University of New York | A or B Plymouth State University | Plan B Ramapo College of New Jersey | A or B Rhode Island College | Plan B Rutgers College, Rutgers University | Plan A San Jose State University | A or B Simon Fraser University | A or B Sir Wilfred Grenfell College | Plan B Sonoma State University | A or B South Carolina State University | Plan B South Dakota State University | A or B Southern Oregon University | A or B Southern University | A or B Southern Utah University | No Plan Southern Utah University | A or B Southwest Missouri State University | A or B St. Mary's College of Maryland | Plan B Stony Brook University | A or B SUNY College at Buffalo | A or B SUNY College at Potsdam | A or B Tennessee State University | A or B Texas State University-San Marcos | A or B The College of New Jersey | A or B Towson University | Plan B Tuskegee University | Plan B Universidad del Sagrado Corazon | A or B Universite de Sherbrooke | Plan B University College of Cape Breton | A or B University of Alabama | A or B University of Alaska Anchorage | A or B University of Alaska Fairbanks | A or B University of Alaska Southeast | A or B University of Arizona | Plan B University of Central Florida | Plan B University of Connecticut | Plan B University of Georgia | Plan B University of Guam | A or B University of Hawaii at Hilo | A or B University of Hawaii at Manoa | A or B University of Idaho | A or B University of Kentucky | Plan B University of Louisville | Plan B University of Maine | A or B University of Maine at Farmington | Plan B University of Maine at Presque Isle | A or B University of Maryland at College Park | Plan B University of Massachusetts at Amherst | A or B University of Massachusetts at Boston | A or B University of Memphis | A or B University of Minnesota, Morris | A or B University of Minnesota, Twin Cities | Plan A University of Mississippi | Plan B University of Missouri-St. Louis | A or B University of Montana | A or B University of Nebraska at Kearney | A or B University of Nevada, Las Vegas | A or B University of Nevada, Reno | A or B University of New Hampshire | Plan B University of New Mexico | Plan B University of New Orleans | A or B University of North Carolina at Asheville | Plan B University of North Carolina at Wilmington | Plan B University of North Texas | A or B University of Northern British Columbia | A or B University of Northern Colorado | Plan B University of Northern Iowa | Plan B University of Oregon | A or B University of Puerto Rico, Bayamon | A or B University of Puerto Rico, Cayey | A or B University of Puerto Rico, Humacao | A or B University of Puerto Rico, Mayaguez | A or B University of Puerto Rico, Rio Piedras | A or B University of Regina | A or B University of Rhode Island | A or B University of South Carolina | Plan B University of South Dakota | A or B University of South Florida | A or B University of Southern Maine | A or B University of Tennessee | A or B University of Tennessee at Chattanooga | A or B University of Texas at El Paso | A or B University of Texas at San Antonio | A or B University of the Virgin Islands, St. Croix | A or B University of the Virgin Islands, St. Thomas | A or B University of Utah | A or B University of Washington | A or B University of West Florida | Plan B University of Wisconsin-Eau Claire | Plan B University of Wisconsin-Green Bay | Plan B University of Wisconsin-Platteville | Plan B University of Wisconsin-River Falls | Plan B University of Wisconsin-Whitewater | Plan B University of Wyoming | A or B Utah State University | A or B Virginia Commonwealth University | Plan B Washington State University | Plan B Wesleyan College | Plan B West Chester University of Pennsylvania | A or B West Virginia University | A or B Western Carolina University | Plan B Western State College of Colorado | A or B Western Washington University | A or B Westfield State College | A or B Wichita State University | Plan B Winthrop University | Plan B
*School Choice 2 Plan:
Plan A Plan B A or B Prefer A Prefer B

*School Choice 3:
School 3 Alabama A & M University | A or B Alabama State University | A or B Arkansas State University | A or B Ball State University | Plan B Binghamton University | A or B Bishop's University | Plan B Boise State University | A or B Bowie State University | Plan B Bowling Green State University | A or B Bridgewater State College | A or B California Polytechnic State U, San Luis Obispo | A or B California State Polytechnic University, Pomona | A or B California State University, Bakersfield | A or B California State University, Chico | A or B California State University, Fresno | A or B California State University, Hayward | A or B California State University, Los Angeles | A or B California State University, Monterey Bay | Plan B California State University, Northridge | A or B California State University, San Bernardino | A or B California University of Pennsylvania | A or B Central Washington University | A or B Cleveland State University | A or B College of Charleston | Plan B East Central University | A or B East Stroudsburg University of Pennsylvania | A or B East Tennessee State University | A or B Eastern Connecticut State University | Plan B Eastern New Mexico University | Plan B Eastern Oregon University | A or B Fairmont State College | A or B Ferris State University | A or B Florida International University | A or B Fort Hays State University | Plan B Framingham State College | Plan B George Mason University | No Plan Grambling State University | A or B Howard University | Plan B Humboldt State University | A or B Hunter College, City University of New York | A or B Idaho State University | A or B Illinois State University | A or B Indiana University of Pennsylvania | A or B Indiana University-Purdue University Fort Wayne | Plan B Inter American Univ of Puerto Rico-San German | A or B Iowa State University | A or B Johnson State College | A or B Keene State College | Plan B Kent State University | A or B Kutztown University of Pennsylvania | No Plan Louisiana State University | A or B Marshall University | Plan B Mesa State College | A or B Michigan Technological University | Plan B Minnesota State University Moorhead | A or B Minnesota State University, Mankato | Plan B Mississippi State University | Plan B Montana State University | A or B Morehead State University | Plan B Murray State University | A or B NC State University | A or B New College of Florida | Plan B New Mexico Institute of Mining and Technology | Plan B New Mexico State University | Plan B North Carolina Central University | A or B Northeastern Illinois University | A or B Northern Arizona University | A or B Northern State University | Plan B Oklahoma State University | A or B Oregon State University | A or B Plattsburgh State University of New York | A or B Plymouth State University | Plan B Ramapo College of New Jersey | A or B Rhode Island College | Plan B Rutgers College, Rutgers University | Plan A San Jose State University | A or B Simon Fraser University | A or B Sir Wilfred Grenfell College | Plan B Sonoma State University | A or B South Carolina State University | Plan B South Dakota State University | A or B Southern Oregon University | A or B Southern University | A or B Southern Utah University | No Plan Southern Utah University | A or B Southwest Missouri State University | A or B St. Mary's College of Maryland | Plan B Stony Brook University | A or B SUNY College at Buffalo | A or B SUNY College at Potsdam | A or B Tennessee State University | A or B Texas State University-San Marcos | A or B The College of New Jersey | A or B Towson University | Plan B Tuskegee University | Plan B Universidad del Sagrado Corazon | A or B Universite de Sherbrooke | Plan B University College of Cape Breton | A or B University of Alabama | A or B University of Alaska Anchorage | A or B University of Alaska Fairbanks | A or B University of Alaska Southeast | A or B University of Arizona | Plan B University of Central Florida | Plan B University of Connecticut | Plan B University of Georgia | Plan B University of Guam | A or B University of Hawaii at Hilo | A or B University of Hawaii at Manoa | A or B University of Idaho | A or B University of Kentucky | Plan B University of Louisville | Plan B University of Maine | A or B University of Maine at Farmington | Plan B University of Maine at Presque Isle | A or B University of Maryland at College Park | Plan B University of Massachusetts at Amherst | A or B University of Massachusetts at Boston | A or B University of Memphis | A or B University of Minnesota, Morris | A or B University of Minnesota, Twin Cities | Plan A University of Mississippi | Plan B University of Missouri-St. Louis | A or B University of Montana | A or B University of Nebraska at Kearney | A or B University of Nevada, Las Vegas | A or B University of Nevada, Reno | A or B University of New Hampshire | Plan B University of New Mexico | Plan B University of New Orleans | A or B University of North Carolina at Asheville | Plan B University of North Carolina at Wilmington | Plan B University of North Texas | A or B University of Northern British Columbia | A or B University of Northern Colorado | Plan B University of Northern Iowa | Plan B University of Oregon | A or B University of Puerto Rico, Bayamon | A or B University of Puerto Rico, Cayey | A or B University of Puerto Rico, Humacao | A or B University of Puerto Rico, Mayaguez | A or B University of Puerto Rico, Rio Piedras | A or B University of Regina | A or B University of Rhode Island | A or B University of South Carolina | Plan B University of South Dakota | A or B University of South Florida | A or B University of Southern Maine | A or B University of Tennessee | A or B University of Tennessee at Chattanooga | A or B University of Texas at El Paso | A or B University of Texas at San Antonio | A or B University of the Virgin Islands, St. Croix | A or B University of the Virgin Islands, St. Thomas | A or B University of Utah | A or B University of Washington | A or B University of West Florida | Plan B University of Wisconsin-Eau Claire | Plan B University of Wisconsin-Green Bay | Plan B University of Wisconsin-Platteville | Plan B University of Wisconsin-River Falls | Plan B University of Wisconsin-Whitewater | Plan B University of Wyoming | A or B Utah State University | A or B Virginia Commonwealth University | Plan B Washington State University | Plan B Wesleyan College | Plan B West Chester University of Pennsylvania | A or B West Virginia University | A or B Western Carolina University | Plan B Western State College of Colorado | A or B Western Washington University | A or B Westfield State College | A or B Wichita State University | Plan B Winthrop University | Plan B
*School Choice 3 Plan:
Plan A Plan B A or B Prefer A Prefer B

*School Choice 4:
School 4 Alabama A & M University | A or B Alabama State University | A or B Arkansas State University | A or B Ball State University | Plan B Binghamton University | A or B Bishop's University | Plan B Boise State University | A or B Bowie State University | Plan B Bowling Green State University | A or B Bridgewater State College | A or B California Polytechnic State U, San Luis Obispo | A or B California State Polytechnic University, Pomona | A or B California State University, Bakersfield | A or B California State University, Chico | A or B California State University, Fresno | A or B California State University, Hayward | A or B California State University, Los Angeles | A or B California State University, Monterey Bay | Plan B California State University, Northridge | A or B California State University, San Bernardino | A or B California University of Pennsylvania | A or B Central Washington University | A or B Cleveland State University | A or B College of Charleston | Plan B East Central University | A or B East Stroudsburg University of Pennsylvania | A or B East Tennessee State University | A or B Eastern Connecticut State University | Plan B Eastern New Mexico University | Plan B Eastern Oregon University | A or B Fairmont State College | A or B Ferris State University | A or B Florida International University | A or B Fort Hays State University | Plan B Framingham State College | Plan B George Mason University | No Plan Grambling State University | A or B Howard University | Plan B Humboldt State University | A or B Hunter College, City University of New York | A or B Idaho State University | A or B Illinois State University | A or B Indiana University of Pennsylvania | A or B Indiana University-Purdue University Fort Wayne | Plan B Inter American Univ of Puerto Rico-San German | A or B Iowa State University | A or B Johnson State College | A or B Keene State College | Plan B Kent State University | A or B Kutztown University of Pennsylvania | No Plan Louisiana State University | A or B Marshall University | Plan B Mesa State College | A or B Michigan Technological University | Plan B Minnesota State University Moorhead | A or B Minnesota State University, Mankato | Plan B Mississippi State University | Plan B Montana State University | A or B Morehead State University | Plan B Murray State University | A or B NC State University | A or B New College of Florida | Plan B New Mexico Institute of Mining and Technology | Plan B New Mexico State University | Plan B North Carolina Central University | A or B Northeastern Illinois University | A or B Northern Arizona University | A or B Northern State University | Plan B Oklahoma State University | A or B Oregon State University | A or B Plattsburgh State University of New York | A or B Plymouth State University | Plan B Ramapo College of New Jersey | A or B Rhode Island College | Plan B Rutgers College, Rutgers University | Plan A San Jose State University | A or B Simon Fraser University | A or B Sir Wilfred Grenfell College | Plan B Sonoma State University | A or B South Carolina State University | Plan B South Dakota State University | A or B Southern Oregon University | A or B Southern University | A or B Southern Utah University | No Plan Southern Utah University | A or B Southwest Missouri State University | A or B St. Mary's College of Maryland | Plan B Stony Brook University | A or B SUNY College at Buffalo | A or B SUNY College at Potsdam | A or B Tennessee State University | A or B Texas State University-San Marcos | A or B The College of New Jersey | A or B Towson University | Plan B Tuskegee University | Plan B Universidad del Sagrado Corazon | A or B Universite de Sherbrooke | Plan B University College of Cape Breton | A or B University of Alabama | A or B University of Alaska Anchorage | A or B University of Alaska Fairbanks | A or B University of Alaska Southeast | A or B University of Arizona | Plan B University of Central Florida | Plan B University of Connecticut | Plan B University of Georgia | Plan B University of Guam | A or B University of Hawaii at Hilo | A or B University of Hawaii at Manoa | A or B University of Idaho | A or B University of Kentucky | Plan B University of Louisville | Plan B University of Maine | A or B University of Maine at Farmington | Plan B University of Maine at Presque Isle | A or B University of Maryland at College Park | Plan B University of Massachusetts at Amherst | A or B University of Massachusetts at Boston | A or B University of Memphis | A or B University of Minnesota, Morris | A or B University of Minnesota, Twin Cities | Plan A University of Mississippi | Plan B University of Missouri-St. Louis | A or B University of Montana | A or B University of Nebraska at Kearney | A or B University of Nevada, Las Vegas | A or B University of Nevada, Reno | A or B University of New Hampshire | Plan B University of New Mexico | Plan B University of New Orleans | A or B University of North Carolina at Asheville | Plan B University of North Carolina at Wilmington | Plan B University of North Texas | A or B University of Northern British Columbia | A or B University of Northern Colorado | Plan B University of Northern Iowa | Plan B University of Oregon | A or B University of Puerto Rico, Bayamon | A or B University of Puerto Rico, Cayey | A or B University of Puerto Rico, Humacao | A or B University of Puerto Rico, Mayaguez | A or B University of Puerto Rico, Rio Piedras | A or B University of Regina | A or B University of Rhode Island | A or B University of South Carolina | Plan B University of South Dakota | A or B University of South Florida | A or B University of Southern Maine | A or B University of Tennessee | A or B University of Tennessee at Chattanooga | A or B University of Texas at El Paso | A or B University of Texas at San Antonio | A or B University of the Virgin Islands, St. Croix | A or B University of the Virgin Islands, St. Thomas | A or B University of Utah | A or B University of Washington | A or B University of West Florida | Plan B University of Wisconsin-Eau Claire | Plan B University of Wisconsin-Green Bay | Plan B University of Wisconsin-Platteville | Plan B University of Wisconsin-River Falls | Plan B University of Wisconsin-Whitewater | Plan B University of Wyoming | A or B Utah State University | A or B Virginia Commonwealth University | Plan B Washington State University | Plan B Wesleyan College | Plan B West Chester University of Pennsylvania | A or B West Virginia University | A or B Western Carolina University | Plan B Western State College of Colorado | A or B Western Washington University | A or B Westfield State College | A or B Wichita State University | Plan B Winthrop University | Plan B
*School Choice 4 Plan:
Plan A Plan B A or B Prefer A Prefer B

*School Choice 5:
School 5 Alabama A & M University | A or B Alabama State University | A or B Arkansas State University | A or B Ball State University | Plan B Binghamton University | A or B Bishop's University | Plan B Boise State University | A or B Bowie State University | Plan B Bowling Green State University | A or B Bridgewater State College | A or B California Polytechnic State U, San Luis Obispo | A or B California State Polytechnic University, Pomona | A or B California State University, Bakersfield | A or B California State University, Chico | A or B California State University, Fresno | A or B California State University, Hayward | A or B California State University, Los Angeles | A or B California State University, Monterey Bay | Plan B California State University, Northridge | A or B California State University, San Bernardino | A or B California University of Pennsylvania | A or B Central Washington University | A or B Cleveland State University | A or B College of Charleston | Plan B East Central University | A or B East Stroudsburg University of Pennsylvania | A or B East Tennessee State University | A or B Eastern Connecticut State University | Plan B Eastern New Mexico University | Plan B Eastern Oregon University | A or B Fairmont State College | A or B Ferris State University | A or B Florida International University | A or B Fort Hays State University | Plan B Framingham State College | Plan B George Mason University | No Plan Grambling State University | A or B Howard University | Plan B Humboldt State University | A or B Hunter College, City University of New York | A or B Idaho State University | A or B Illinois State University | A or B Indiana University of Pennsylvania | A or B Indiana University-Purdue University Fort Wayne | Plan B Inter American Univ of Puerto Rico-San German | A or B Iowa State University | A or B Johnson State College | A or B Keene State College | Plan B Kent State University | A or B Kutztown University of Pennsylvania | No Plan Louisiana State University | A or B Marshall University | Plan B Mesa State College | A or B Michigan Technological University | Plan B Minnesota State University Moorhead | A or B Minnesota State University, Mankato | Plan B Mississippi State University | Plan B Montana State University | A or B Morehead State University | Plan B Murray State University | A or B NC State University | A or B New College of Florida | Plan B New Mexico Institute of Mining and Technology | Plan B New Mexico State University | Plan B North Carolina Central University | A or B Northeastern Illinois University | A or B Northern Arizona University | A or B Northern State University | Plan B Oklahoma State University | A or B Oregon State University | A or B Plattsburgh State University of New York | A or B Plymouth State University | Plan B Ramapo College of New Jersey | A or B Rhode Island College | Plan B Rutgers College, Rutgers University | Plan A San Jose State University | A or B Simon Fraser University | A or B Sir Wilfred Grenfell College | Plan B Sonoma State University | A or B South Carolina State University | Plan B South Dakota State University | A or B Southern Oregon University | A or B Southern University | A or B Southern Utah University | No Plan Southern Utah University | A or B Southwest Missouri State University | A or B St. Mary's College of Maryland | Plan B Stony Brook University | A or B SUNY College at Buffalo | A or B SUNY College at Potsdam | A or B Tennessee State University | A or B Texas State University-San Marcos | A or B The College of New Jersey | A or B Towson University | Plan B Tuskegee University | Plan B Universidad del Sagrado Corazon | A or B Universite de Sherbrooke | Plan B University College of Cape Breton | A or B University of Alabama | A or B University of Alaska Anchorage | A or B University of Alaska Fairbanks | A or B University of Alaska Southeast | A or B University of Arizona | Plan B University of Central Florida | Plan B University of Connecticut | Plan B University of Georgia | Plan B University of Guam | A or B University of Hawaii at Hilo | A or B University of Hawaii at Manoa | A or B University of Idaho | A or B University of Kentucky | Plan B University of Louisville | Plan B University of Maine | A or B University of Maine at Farmington | Plan B University of Maine at Presque Isle | A or B University of Maryland at College Park | Plan B University of Massachusetts at Amherst | A or B University of Massachusetts at Boston | A or B University of Memphis | A or B University of Minnesota, Morris | A or B University of Minnesota, Twin Cities | Plan A University of Mississippi | Plan B University of Missouri-St. Louis | A or B University of Montana | A or B University of Nebraska at Kearney | A or B University of Nevada, Las Vegas | A or B University of Nevada, Reno | A or B University of New Hampshire | Plan B University of New Mexico | Plan B University of New Orleans | A or B University of North Carolina at Asheville | Plan B University of North Carolina at Wilmington | Plan B University of North Texas | A or B University of Northern British Columbia | A or B University of Northern Colorado | Plan B University of Northern Iowa | Plan B University of Oregon | A or B University of Puerto Rico, Bayamon | A or B University of Puerto Rico, Cayey | A or B University of Puerto Rico, Humacao | A or B University of Puerto Rico, Mayaguez | A or B University of Puerto Rico, Rio Piedras | A or B University of Regina | A or B University of Rhode Island | A or B University of South Carolina | Plan B University of South Dakota | A or B University of South Florida | A or B University of Southern Maine | A or B University of Tennessee | A or B University of Tennessee at Chattanooga | A or B University of Texas at El Paso | A or B University of Texas at San Antonio | A or B University of the Virgin Islands, St. Croix | A or B University of the Virgin Islands, St. Thomas | A or B University of Utah | A or B University of Washington | A or B University of West Florida | Plan B University of Wisconsin-Eau Claire | Plan B University of Wisconsin-Green Bay | Plan B University of Wisconsin-Platteville | Plan B University of Wisconsin-River Falls | Plan B University of Wisconsin-Whitewater | Plan B University of Wyoming | A or B Utah State University | A or B Virginia Commonwealth University | Plan B Washington State University | Plan B Wesleyan College | Plan B West Chester University of Pennsylvania | A or B West Virginia University | A or B Western Carolina University | Plan B Western State College of Colorado | A or B Western Washington University | A or B Westfield State College | A or B Wichita State University | Plan B Winthrop University | Plan B
*School Choice 5 Plan:
Plan A Plan B A or B Prefer A Prefer B

*Academic Year:
Make Selection... Academic Year Fall Semester Spring Semester Fall Quarter Winter Quarter Spring Quarter Summer Summer + Academic Year Summer + Fall Semester Summer Q. + Fall Q. Academic Year + Summer Spring Semester + Summer Winter Q. + Spring Q. + Summer Spring Q. + Summer Winter Q. + Spring Q. Fall Q. + Winter Q. Fall Q. + Winter Q. + Summer

Have you ever been coonvicted of a felony?:
Yes
No

Are you on probation, parole, or have any legal judgements pending against you either inside or outside campus?:
Yes
No

If yes, please explain:

Are you currently under any campus disciplinary action for violation of codes of academic or student conduct?:
Yes
No

If yes, please explain:

Do you have any outstanding indebtedness to the campus?:
Yes
No

Name:

Relationship:

Address:

(Please include a full address with state or province as well as zip or postal code.)

E-mail: