Fillable 03 Admissions Application

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03 Admissions Application

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A p p l i c A t i o n F o r A d m i s s i o n
Application Requirements
A. Beginning Freshman Applicants
Completed application with $20 non-refundable fee
Ofcial high school transcript and/or GED scores
Ofcial SAT or ACT scores (Test scores are not required for
admission; however, scores may be used to exempt placement testing)
Compass Placement Test (If applicable)
Proof of Immunization
B. Accel/Joint Enrollment Applicants
Completed application with $20 non-refundable fee
Accel application (Must be completed online at www.gacollege411.org)
Ofcial high school transcript
Ofcial SAT or ACT scores
Proof of Immunization
C. Transfer Applicants
Completed application with $20 non-refundable fee
Ofcial transcripts from each college attended (If currently
enrolled, send preliminary transcripts now and nal transcripts upon
term completed)
If less than 30 hours of college credit, meet requirements for
beginning freshmen (see above)
Proof of Immunization
D. Transient Applicants
Completed application with $20 non-refundable fee
Ofcial letter of transient permission from home institution
Proof of Immunization
E. Homeschooled Applicants
Complete application with $20 non-refundable fee
Ofcial high school transcript
Ofcial SAT or ACT scores
Compass Placement Test (If applicable)
Proof of Immunization
F. Non-Degree Seeking Applicants
(Those seeking credit but not a degree)
Complete application with $20 non-refundable fee
Meet requirements of the appropriate category previously listed
above or provide proof of a four-year degree
Proof of Immunization
G. Auditors
(Those wishing to enroll without receiving academic credit)
Completed application with $20 non-refundable fee
Meet requirements of the appropriate category previously listed
above or provide proof of a four-year degree
Proof of Immunization
H. Non-Traditional Student Applicant
(Those who have not attended high school or college in
thepreviousveyearsandhaveearnedfewerthan30
transferrablesemesterhoursofcredit)
Completed application with $20 non-refundable fee
Ofcial high school transcript with graduation date or
ofcial copy of GED test scores
Ofcial copies of all college transcripts
Proof of Immunization
I. Post-Baccalaureate
Completed application with $20 non-refundable fee
Proof of degree
Proof of Immunization
Follow the instructions listed above carefully
in order to expedite the processing of your
application. If you need help please contact
the Ofce of Admissions at (229) 317-6859
or call toll free at (866) 775-1214.
Return completed application to:
DirectorofAdmissions
Darton State College
2400GillionvilleRoad
Albany,GA31707
Enclose a $20, non-refundable application fee.
GeneralDeadlines: Applications and all
required supporting credentials must be
received by the Ofce of Admissions prior
to consideration of the application.
1 2 3
STATE COLLEGE
Early Application is Strongly Advised
University System of Georgia • An Afrmative Action / Equal Opportunity Educational Institution
The applicant should check the current College catalog for more specic details concerning admissions procedures and requirements.
A p p l i c A t i o n F o r A d m i s s i o n
E. Resident/Tuition Classication Status
Tuition Classication Information: University System of Georgia students are responsible for registering under the proper tuition classication. In general, classi-
cation of in-state status for tuition purposes requires an individual to have established domicile in Georgia for a minimum of 12 consecutive months immediately
preceding the rst day of classes for the term in which the student plans to enroll. Domicile is dened as a person’s present, permanent home where the individual
intends to stay indenitely and to which the individual returns following periods of temporary absence. Temporary residence does not constitute the establishment
of one’s domicile. Residency is dened as the state and country where an individual currently lives. An individual may reside in Georgia without having estab-
lished domicile in the state.
Resident of Georgia. If a resident, how long have you lived in Georgia? County of Residency:
Non-resident of Georgia. State of Residency:
Non-resident of Georgia. Military or Military family member. Home State of Record:
Are you applying for in-state tuition? Yes No
If you answered “Yes” to the above question, all of the following must be answered.
Yes No Have you established and maintained domicile in Georgia (according to the denition above) for at least 12 consecutive months immediately
preceding the rst day of classes for the tern in which you plan to enroll?
Yes No If you are under the age of 24, has a parent(s) or US court-appointed legal guardian established and maintained legal guardian established and
maintained legal residence and domicile in Georgia for at least 12 consecutive months immediately preceding the rst day of classes for the
term in which you plan to enroll?
Yes No Have you ever lived outside the state of Georgia?
If yes, how long have you continuously resided in the state of Georgia? Years: Months: Date:
If you ever lived outside the state of Georgia, what was your primary reason for moving to the state (check all that apply):
Part-time work Full-time work Employment of Spouse Employment of Parent/Guardian Attend School
Family Reasons Return to state following school attendance in another state
Yes No Have you attended a Georgia high school for at least one year?
Yes No Have you graduated or will you graduate from a Georgia high school?
Yes No Do you have a US state/territory-issued driver’s license or ID? If yes, in which state?
Yes No Do you own a motor vehicle? If yes, in which state is it registered?
Yes No Do you have a voter registration? If yes, in which state are you registered?
Yes No Did you (or your parents if you are claimed as a dependent) le a state income tax return this past year?
If yes, in which state did you le?
Yes No Are you currently a member of the Georgia National Guard or a family member of someone who is a member of the Georgia National Guard?
Home State of Record
F. Military Information
Are you, or will you, be at the time of enrollment a current member or veteran of the U.S. Armed Forces? Yes No If yes, which branch?
Air Force Army Coast Guard Marines Navy
Current Status: Serving Discharged Retired
What is your home state of record? Are you stationed or assigned to Georgia?
Yes No Are you the spouse or dependent child under the age of 24 of someone who is currently active duty, a veteran, a member of the National Guard,
or a Reservist in the U.S, Armed Forces?
If yes, answer the following questions: What is the military member’s branch?
What is the military member’s home state of record?
Is the military member stationed or assigned to Georgia?
I understand that as a Darton State College student , I may be photographed during events held on campus. I agree that my image may be published and distributed
in whole or in part for education, instruction, or promotional purposes in print or over open broadcast, cable, audiovisual, radio, closed-circuit exhibition, or
computer link. Said work will become the sole property of Darton State College, and I release Darton State College from all claims based on said work.
I understand that any material false statements made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance
with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a ne of not
more than $1,000 or by imprisonment for not less than one nor more than ve years, or both, subject me to prosecution in a court of law. Additionally, I further
understand that any such false statement may subject me to immediate dismissal from the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
Signature: Date:
Ofce of Admissions - (229) 317-6859 • (866) 775-1214
Information and Instructions - Pleasetypeorprintlegiblyinink.
4
A p p l i c A t i o n F o r A d m i s s i o n
Degree Programs
Bachelor of Science Degree
Nursing(BSN)..................................................................0653
Associate of Arts (A.A.)
Transfer Program
Art .................................................................................. 0002
Dance ............................................................................. 0077
English ........................................................................... 0022
Foreign Language .......................................................... 0023
History ........................................................................... 0033
Journalism .............................................. ....................... 0009
Print.... .......................................................................1009
Broadcast ...................................................................2009
Music ............................................................................. 0011
Philosophy ..................................................................... 0034
Speech .................................................... ....................... 0016
Theater ........................................................................... 0075
Design .......................................................................0078
Performance ...................................... ........................0075
Associate of Science (A.S.)
Transfer Program
Agriculture ..................................................................... 0001
Anthropology ................................................................. 0093
Biological Science ......................................................... 0003
Biomedical Technology ................................................. 0055
Business Administration ................................................ 0004
Business Education ........................................................ 0005
Chemistry .......................................................................0006
Computer Information Systems ..................................... 0091
Computer Science .......................................................... 0041
Criminal Justice ............................................................. 0019
Economics ..................................................................... 0073
Engineering Technology ................................................ 0047
Environmental Science .................................................. 0074
Forensic Science ............................................................ 0097
Forestry .......................................................................... 0008
General Studies .............................................................. 0099
Geography ......................................................................0032
Health and Physical Education
Exercise Science Option ........................................... 3018
Recreation Option ..................................................... 1018
Sports Management Option ...................................... 2018
Health Information Management ...................................0025
Health Sciences...............................................................0063
Mathematics ...................................................................0010
Nuclear Medicine Technology ....................................... 0049
Nursing .......................................................................... 0029
Ofce Administration .................................................... 0042
Physics ........................................................................... 0012
Political Science ............................................................ 0035
Pre-Dentistry .................................................................. 0028
Pre-Engineering ............................................................. 0044
Pre-Law ..........................................................................0040
Pre-Medicine ..................................................................0038
Pre-Optometry ................................................................0039
Pre-Pharmacy .................................................................0013
Pre-Physician’s Assistant ............................................... 0045
Pre-Veterinary Medicine ................................................ 0030
Psychology .................................................................... 0036
Social Work ....................................................................0071
Sociology ....................................................................... 0037
Teacher Education
Early Childhood ........................................................ 0088
Middle Grades Education ......................................... 0089
Secondary Education ................................................ 0014
Humanities
Art ............................................................................. 0014
English ...................................................................... 2014
Foreign Language ..................................................... 3014
Mathematics ............................................................. 4014
Music ........................................................................ 5014
Social Science ........................................................... 6014
Speech ....................................................................... 7014
Theatre ...................................................................... 8014
Special Education ..................................................... 9014
Trade & Industrial Education.................................... 0092
Associate of Science Health
Pre-Baccalaureate Career Programs
Career Programs
Cancer Registry ............................................................. 0387
Cardiovascular Technology ........................................... 0281
Dental Hygiene .............................................................. 0355
Diagnostic Medical Sonography..................................... 0382
Emergency Medical Services ........................................ 0367
Health Information Technology ..................................... 0370
Human Services Technology ......................................... 0371
Medical Laboratory Technology ................................... 0365
Nursing .......................................................................... 0353
Nursing Healthcare Professional Bridge ....................... 4353
Occupational Therapy Assistant .................................... 0372
Physical Therapy Assistant ............................................ 0363
Polysomnography .......................................................... 0384
Radiologic Science ........................................................ 0388
Respiratory Therapy ...................................................... 0366
Associate of Applied Science
Pre-Baccalaureate Career Programs
Accounting .................................................................... 0358
Histologic Technology ................................................... 0373
Management .................................................................. 0351
Paralegal Studies ........................................................... 0383
Certicate Programs
Addiction Counseling ................................................... 0570
Business Computer Systems
Cisco ......................................................................... 6576
Computer Technology .............................................. 5576
Church Music ................................................................ 0565
Cancer Registry Management ........................................0590
Computed Tomography ................................................. 0567
Emergency Medical Services .........................................0566
Emergency Medical Technician .....................................0589
Graphic Design .............................................................. 0574
Histology ....................................................................... 0564
Criminal Justice Management ....................................... 4586
Medical Coding ............................................................. 0563
Middle Grades Math Certicate .................................... 0581
Middle Grades Science Certicate ................................ 0582
Paralegal Studies ........................................................... 0542
Phlebotomy .................................................................... 0599
Professional Writing ...................................................... 0535
Psychiatric Technology Certicate ................................ 0573
Small Business Management ......................................... 0587
Spanish for Healthcare Professionals ............................ 0540
Teacher Communication & Crisis Management ........... 0572
Technical Theatre .......................................................... 0541
Video Techniques & Applications ................................. 0569
Visual Communication .................................................. 0537
Other
Undecided ...................................................................... 0050
Non-Degree Seeking ......................................................0999
Did I complete and submit FAFSA (application for Pell Grant
and HOPE Scholarship) at www.fafsa.gov?
Did I receive an email conrmation FAFSA was received?
Did I receive a letter stating I was selected for verication
documentation?
Did I return all requested verication documentation to
Darton’s Financial Aid Ofce?
Did I contact the Financial Aid Ofce or login to MyDC
Banner web to verify my le is complete and no additional
information is needed to determine award?
Did I receive and review my award letter?
Did I login to MyDC Banner web to authorize and accept my
nancial aid award?
If additional funding is needed, did I contact the Financial Aid
Ofce at (229) 317-6746?
If I want a Direct Student Loan, did I apply at
www.darton.edu/naid?
Do my parents need to apply for a Direct Plus Loan?
If denied the Plus Loan, did I notify the Financial Aid Ofce?
Do I have enough funds to cover tuition, fees, books, and if
living on campus, housing and meal plan?
Financial Aid Checklist
Darton State College is committed to protecting the privacy of its students,
employees, and alumni, as well as other individuals associated with it. At
times the Institution will ask you for your Social Security number. Federal
and state law requires the collection of your Social Security number for
certain purposes such as those relating to employment and student aid.
Whenever your Social Security number is requested, the electronic or
physical form used to collect your number will be clearly marked as to
whether this request is voluntary or mandatory.
Further, the Institution is required to have a valid Social Security number
before an individual can be entered into any business system involving
nancial transactions. Thus without your Social Security number, the
Institution cannot grant an assistantship or waiver, or provide employment.
Providing the Institution with your Social Security number in advance is the
safest way to ensure that these services are available with the least delay.
Housing Information
To begin an application for on-campus housing visit http://housing.darton.edu.
Prospective students need to have applied to Darton State College prior to
applying for housing. Housing is limited, so students are encouraged to apply
early.
Verication of Lawful Presence
In accordance with Board of Regents Policy 4.3.4, all applicants who are
accepted for admission or readmission to Darton State College for Fall 2011 or
any academic semester thereafter, and who seek to be classied as in-state for
tuition purposes will be required to provide validation of residency in both the
State of Georgia and the United States. Please go to www.darton.edu/admissions
to see a list of documents which satisfy this requirement.
Primary Campus
Main Cordele East Georgia Thomasville Sandersville On-Line Only
A. Admissions Information (Pleasetypeorprintclearly)
This information is required in considering the applicant’s request for admission.
Name: Mr. Mrs. Ms. (Last), (First), (Middle)
Social Security Number: Date of Birth:
Preferred First Name: Previous/Maiden Name:
Mailing Address: Home Phone: ( ) Cell Phone: ( )
City: State: Zip: Email:
Graduated from high school or expect to graduate: , or GED received on:
Name of High School: City/State:
Have you taken the Scholastic Aptitude (SAT) or the ACT Assessment?
Have you ever applied to this institution before? If so, when?
Have you ever attended this institution before? If so, when?
During which semester do you rst plan to enroll? Fall Spring Summer Year
Applying as: Beginning Freshman Accel/Joint Enrollment Transfer Post Baccalaureate
Transient Non-Degree Seeking Audit
Do you plan to graduate from Darton State College? Yes No
If you are a college transfer, give the names of all previous colleges and/or technical colleges, dates of attendance, and degrees earned, if applicable
Name of College City/State Dates Attended Degrees Earned
Transient students give name of institution currently attending:
Proposed college major (see codes on page two):
B. Statistical Information
The following information is used in Federal and State reports which collect data on equal opportunity for education and employment.
Your response does not affect your admission to Darton State College.
Gender (optional): Male Female
Marital Status: Married Single
Ethnic Status: Are you Hispanic or Latino? Yes No
Race: White American Indian or Alaskan Native Black or African American
Native Hawaiian or other Pacic Islander Asian
C. Personal Information
In case of emergency, contact: at: ( )
Relation to Student :
How did you rst learn of Darton State College? Relative Friend High School Teacher/Counselor
Darton Representative Other:
Have you ever been CHARGED WITH, convicted of, or have charges pending for a violation of any law other than minor trafc violations?
No __Yes___ (Please explain. If needed, write explanation on separate piece of paper)
D. Citizenship Information
Country of Birth: Country of Citizenship (if not U. S.):
Citizenship Status: U.S. Citizen by Birth U.S. Citizen by Naturalization
Resident Alien (please attach a copy of both sides of permanent resident card)
Non-Resident Alien: Visa Type:
Is English your native language? If no, name your native language:
Was all of your instruction throughout secondary school in English? Yes No
A p p l i c A t i o n F o r A d m i s s i o n
What is the highest level of education obtained by your parent(s)/guardian?
Parent/Guardian 1: _________
Parent/Guardian 2: _________
Responseoptionsareasfollows:
(A) Less than high school
(B) High School Diploma or equivalent (e.g. GED)
(C) Some college but no formal award
(D) Certicate, less than an Associate’s degree
(E) Associate’s degree (A.A., A.S., etc.)
(F) Baccalaureate degree (B.A., B.S., etc.)
(G) Master’s degree (M.A., M.S., etc.)
(H) Doctoral/Professional degree (Ph.D., M.D., J.D., etc.)
(I) Unknown
2 3
A p p l i c A t i o n F o r A d m i s s i o n
Degree Programs
Bachelor of Science Degree
Nursing(BSN)..................................................................0653
Associate of Arts (A.A.)
Transfer Program
Art .................................................................................. 0002
Dance ............................................................................. 0077
English ........................................................................... 0022
Foreign Language .......................................................... 0023
History ........................................................................... 0033
Journalism .............................................. ....................... 0009
Print.... .......................................................................1009
Broadcast ...................................................................2009
Music ............................................................................. 0011
Philosophy ..................................................................... 0034
Speech .................................................... ....................... 0016
Theater ........................................................................... 0075
Design .......................................................................0078
Performance ...................................... ........................0075
Associate of Science (A.S.)
Transfer Program
Agriculture ..................................................................... 0001
Anthropology ................................................................. 0093
Biological Science ......................................................... 0003
Biomedical Technology ................................................. 0055
Business Administration ................................................ 0004
Business Education ........................................................ 0005
Chemistry .......................................................................0006
Computer Information Systems ..................................... 0091
Computer Science .......................................................... 0041
Criminal Justice ............................................................. 0019
Economics ..................................................................... 0073
Engineering Technology ................................................ 0047
Environmental Science .................................................. 0074
Forensic Science ............................................................ 0097
Forestry .......................................................................... 0008
General Studies .............................................................. 0099
Geography ......................................................................0032
Health and Physical Education
Exercise Science Option ........................................... 3018
Recreation Option ..................................................... 1018
Sports Management Option ...................................... 2018
Health Information Management ...................................0025
Health Sciences...............................................................0063
Mathematics ...................................................................0010
Nuclear Medicine Technology ....................................... 0049
Nursing .......................................................................... 0029
Ofce Administration .................................................... 0042
Physics ........................................................................... 0012
Political Science ............................................................ 0035
Pre-Dentistry .................................................................. 0028
Pre-Engineering ............................................................. 0044
Pre-Law ..........................................................................0040
Pre-Medicine ..................................................................0038
Pre-Optometry ................................................................0039
Pre-Pharmacy .................................................................0013
Pre-Physician’s Assistant ............................................... 0045
Pre-Veterinary Medicine ................................................ 0030
Psychology .................................................................... 0036
Social Work ....................................................................0071
Sociology ....................................................................... 0037
Teacher Education
Early Childhood ........................................................ 0088
Middle Grades Education ......................................... 0089
Secondary Education ................................................ 0014
Humanities
Art ............................................................................. 0014
English ...................................................................... 2014
Foreign Language ..................................................... 3014
Mathematics ............................................................. 4014
Music ........................................................................ 5014
Social Science ........................................................... 6014
Speech ....................................................................... 7014
Theatre ...................................................................... 8014
Special Education ..................................................... 9014
Trade & Industrial Education.................................... 0092
Associate of Science Health
Pre-Baccalaureate Career Programs
Career Programs
Cancer Registry ............................................................. 0387
Cardiovascular Technology ........................................... 0281
Dental Hygiene .............................................................. 0355
Diagnostic Medical Sonography..................................... 0382
Emergency Medical Services ........................................ 0367
Health Information Technology ..................................... 0370
Human Services Technology ......................................... 0371
Medical Laboratory Technology ................................... 0365
Nursing .......................................................................... 0353
Nursing Healthcare Professional Bridge ....................... 4353
Occupational Therapy Assistant .................................... 0372
Physical Therapy Assistant ............................................ 0363
Polysomnography .......................................................... 0384
Radiologic Science ........................................................ 0388
Respiratory Therapy ...................................................... 0366
Associate of Applied Science
Pre-Baccalaureate Career Programs
Accounting .................................................................... 0358
Histologic Technology ................................................... 0373
Management .................................................................. 0351
Paralegal Studies ........................................................... 0383
Certicate Programs
Addiction Counseling ................................................... 0570
Business Computer Systems
Cisco ......................................................................... 6576
Computer Technology .............................................. 5576
Church Music ................................................................ 0565
Cancer Registry Management ........................................0590
Computed Tomography ................................................. 0567
Emergency Medical Services .........................................0566
Emergency Medical Technician .....................................0589
Graphic Design .............................................................. 0574
Histology ....................................................................... 0564
Criminal Justice Management ....................................... 4586
Medical Coding ............................................................. 0563
Middle Grades Math Certicate .................................... 0581
Middle Grades Science Certicate ................................ 0582
Paralegal Studies ........................................................... 0542
Phlebotomy .................................................................... 0599
Professional Writing ...................................................... 0535
Psychiatric Technology Certicate ................................ 0573
Small Business Management ......................................... 0587
Spanish for Healthcare Professionals ............................ 0540
Teacher Communication & Crisis Management ........... 0572
Technical Theatre .......................................................... 0541
Video Techniques & Applications ................................. 0569
Visual Communication .................................................. 0537
Other
Undecided ...................................................................... 0050
Non-Degree Seeking ......................................................0999
Did I complete and submit FAFSA (application for Pell Grant
and HOPE Scholarship) at www.fafsa.gov?
Did I receive an email conrmation FAFSA was received?
Did I receive a letter stating I was selected for verication
documentation?
Did I return all requested verication documentation to
Darton’s Financial Aid Ofce?
Did I contact the Financial Aid Ofce or login to MyDC
Banner web to verify my le is complete and no additional
information is needed to determine award?
Did I receive and review my award letter?
Did I login to MyDC Banner web to authorize and accept my
nancial aid award?
If additional funding is needed, did I contact the Financial Aid
Ofce at (229) 317-6746?
If I want a Direct Student Loan, did I apply at
www.darton.edu/naid?
Do my parents need to apply for a Direct Plus Loan?
If denied the Plus Loan, did I notify the Financial Aid Ofce?
Do I have enough funds to cover tuition, fees, books, and if
living on campus, housing and meal plan?
Financial Aid Checklist
Darton State College is committed to protecting the privacy of its students,
employees, and alumni, as well as other individuals associated with it. At
times the Institution will ask you for your Social Security number. Federal
and state law requires the collection of your Social Security number for
certain purposes such as those relating to employment and student aid.
Whenever your Social Security number is requested, the electronic or
physical form used to collect your number will be clearly marked as to
whether this request is voluntary or mandatory.
Further, the Institution is required to have a valid Social Security number
before an individual can be entered into any business system involving
nancial transactions. Thus without your Social Security number, the
Institution cannot grant an assistantship or waiver, or provide employment.
Providing the Institution with your Social Security number in advance is the
safest way to ensure that these services are available with the least delay.
Housing Information
To begin an application for on-campus housing visit http://housing.darton.edu.
Prospective students need to have applied to Darton State College prior to
applying for housing. Housing is limited, so students are encouraged to apply
early.
Verication of Lawful Presence
In accordance with Board of Regents Policy 4.3.4, all applicants who are
accepted for admission or readmission to Darton State College for Fall 2011 or
any academic semester thereafter, and who seek to be classied as in-state for
tuition purposes will be required to provide validation of residency in both the
State of Georgia and the United States. Please go to www.darton.edu/admissions
to see a list of documents which satisfy this requirement.
Primary Campus
Main Cordele East Georgia Thomasville Sandersville On-Line Only
A. Admissions Information (Pleasetypeorprintclearly)
This information is required in considering the applicant’s request for admission.
Name: Mr. Mrs. Ms. (Last), (First), (Middle)
Social Security Number: Date of Birth:
Preferred First Name: Previous/Maiden Name:
Mailing Address: Home Phone: ( ) Cell Phone: ( )
City: State: Zip: Email:
Graduated from high school or expect to graduate: , or GED received on:
Name of High School: City/State:
Have you taken the Scholastic Aptitude (SAT) or the ACT Assessment?
Have you ever applied to this institution before? If so, when?
Have you ever attended this institution before? If so, when?
During which semester do you rst plan to enroll? Fall Spring Summer Year
Applying as: Beginning Freshman Accel/Joint Enrollment Transfer Post Baccalaureate
Transient Non-Degree Seeking Audit
Do you plan to graduate from Darton State College? Yes No
If you are a college transfer, give the names of all previous colleges and/or technical colleges, dates of attendance, and degrees earned, if applicable
Name of College City/State Dates Attended Degrees Earned
Transient students give name of institution currently attending:
Proposed college major (see codes on page two):
B. Statistical Information
The following information is used in Federal and State reports which collect data on equal opportunity for education and employment.
Your response does not affect your admission to Darton State College.
Gender (optional): Male Female
Marital Status: Married Single
Ethnic Status: Are you Hispanic or Latino? Yes No
Race: White American Indian or Alaskan Native Black or African American
Native Hawaiian or other Pacic Islander Asian
C. Personal Information
In case of emergency, contact: at: ( )
Relation to Student :
How did you rst learn of Darton State College? Relative Friend High School Teacher/Counselor
Darton Representative Other:
Have you ever been CHARGED WITH, convicted of, or have charges pending for a violation of any law other than minor trafc violations?
No __Yes___ (Please explain. If needed, write explanation on separate piece of paper)
D. Citizenship Information
Country of Birth: Country of Citizenship (if not U. S.):
Citizenship Status: U.S. Citizen by Birth U.S. Citizen by Naturalization
Resident Alien (please attach a copy of both sides of permanent resident card)
Non-Resident Alien: Visa Type:
Is English your native language? If no, name your native language:
Was all of your instruction throughout secondary school in English? Yes No
A p p l i c A t i o n F o r A d m i s s i o n
What is the highest level of education obtained by your parent(s)/guardian?
Parent/Guardian 1: _________
Parent/Guardian 2: _________
Responseoptionsareasfollows:
(A) Less than high school
(B) High School Diploma or equivalent (e.g. GED)
(C) Some college but no formal award
(D) Certicate, less than an Associate’s degree
(E) Associate’s degree (A.A., A.S., etc.)
(F) Baccalaureate degree (B.A., B.S., etc.)
(G) Master’s degree (M.A., M.S., etc.)
(H) Doctoral/Professional degree (Ph.D., M.D., J.D., etc.)
(I) Unknown
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I
I
A p p l i c A t i o n F o r A d m i s s i o n
Application Requirements
A. Beginning Freshman Applicants
Completed application with $20 non-refundable fee
Ofcial high school transcript and/or GED scores
Ofcial SAT or ACT scores (Test scores are not required for
admission; however, scores may be used to exempt placement testing)
Compass Placement Test (If applicable)
Proof of Immunization
B. Accel/Joint Enrollment Applicants
Completed application with $20 non-refundable fee
Accel application (Must be completed online at www.gacollege411.org)
Ofcial high school transcript
Ofcial SAT or ACT scores
Proof of Immunization
C. Transfer Applicants
Completed application with $20 non-refundable fee
Ofcial transcripts from each college attended (If currently
enrolled, send preliminary transcripts now and nal transcripts upon
term completed)
If less than 30 hours of college credit, meet requirements for
beginning freshmen (see above)
Proof of Immunization
D. Transient Applicants
Completed application with $20 non-refundable fee
Ofcial letter of transient permission from home institution
Proof of Immunization
E. Homeschooled Applicants
Complete application with $20 non-refundable fee
Ofcial high school transcript
Ofcial SAT or ACT scores
Compass Placement Test (If applicable)
Proof of Immunization
F. Non-Degree Seeking Applicants
(Those seeking credit but not a degree)
Complete application with $20 non-refundable fee
Meet requirements of the appropriate category previously listed
above or provide proof of a four-year degree
Proof of Immunization
G. Auditors
(Those wishing to enroll without receiving academic credit)
Completed application with $20 non-refundable fee
Meet requirements of the appropriate category previously listed
above or provide proof of a four-year degree
Proof of Immunization
H. Non-Traditional Student Applicant
(Those who have not attended high school or college in
thepreviousveyearsandhaveearnedfewerthan30
transferrablesemesterhoursofcredit)
Completed application with $20 non-refundable fee
Ofcial high school transcript with graduation date or
ofcial copy of GED test scores
Ofcial copies of all college transcripts
Proof of Immunization
I. Post-Baccalaureate
Completed application with $20 non-refundable fee
Proof of degree
Proof of Immunization
Follow the instructions listed above carefully
in order to expedite the processing of your
application. If you need help please contact
the Ofce of Admissions at (229) 317-6859
or call toll free at (866) 775-1214.
Return completed application to:
DirectorofAdmissions
Darton State College
2400GillionvilleRoad
Albany,GA31707
Enclose a $20, non-refundable application fee.
GeneralDeadlines: Applications and all
required supporting credentials must be
received by the Ofce of Admissions prior
to consideration of the application.
1 2 3
STATE COLLEGE
Early Application is Strongly Advised
University System of Georgia • An Afrmative Action / Equal Opportunity Educational Institution
The applicant should check the current College catalog for more specic details concerning admissions procedures and requirements.
A p p l i c A t i o n F o r A d m i s s i o n
E. Resident/Tuition Classication Status
Tuition Classication Information: University System of Georgia students are responsible for registering under the proper tuition classication. In general, classi-
cation of in-state status for tuition purposes requires an individual to have established domicile in Georgia for a minimum of 12 consecutive months immediately
preceding the rst day of classes for the term in which the student plans to enroll. Domicile is dened as a person’s present, permanent home where the individual
intends to stay indenitely and to which the individual returns following periods of temporary absence. Temporary residence does not constitute the establishment
of one’s domicile. Residency is dened as the state and country where an individual currently lives. An individual may reside in Georgia without having estab-
lished domicile in the state.
Resident of Georgia. If a resident, how long have you lived in Georgia? County of Residency:
Non-resident of Georgia. State of Residency:
Non-resident of Georgia. Military or Military family member. Home State of Record:
Are you applying for in-state tuition? Yes No
If you answered “Yes” to the above question, all of the following must be answered.
Yes No Have you established and maintained domicile in Georgia (according to the denition above) for at least 12 consecutive months immediately
preceding the rst day of classes for the tern in which you plan to enroll?
Yes No If you are under the age of 24, has a parent(s) or US court-appointed legal guardian established and maintained legal guardian established and
maintained legal residence and domicile in Georgia for at least 12 consecutive months immediately preceding the rst day of classes for the
term in which you plan to enroll?
Yes No Have you ever lived outside the state of Georgia?
If yes, how long have you continuously resided in the state of Georgia? Years: Months: Date:
If you ever lived outside the state of Georgia, what was your primary reason for moving to the state (check all that apply):
Part-time work Full-time work Employment of Spouse Employment of Parent/Guardian Attend School
Family Reasons Return to state following school attendance in another state
Yes No Have you attended a Georgia high school for at least one year?
Yes No Have you graduated or will you graduate from a Georgia high school?
Yes No Do you have a US state/territory-issued driver’s license or ID? If yes, in which state?
Yes No Do you own a motor vehicle? If yes, in which state is it registered?
Yes No Do you have a voter registration? If yes, in which state are you registered?
Yes No Did you (or your parents if you are claimed as a dependent) le a state income tax return this past year?
If yes, in which state did you le?
Yes No Are you currently a member of the Georgia National Guard or a family member of someone who is a member of the Georgia National Guard?
Home State of Record
F. Military Information
Are you, or will you, be at the time of enrollment a current member or veteran of the U.S. Armed Forces? Yes No If yes, which branch?
Air Force Army Coast Guard Marines Navy
Current Status: Serving Discharged Retired
What is your home state of record? Are you stationed or assigned to Georgia?
Yes No Are you the spouse or dependent child under the age of 24 of someone who is currently active duty, a veteran, a member of the National Guard,
or a Reservist in the U.S, Armed Forces?
If yes, answer the following questions: What is the military member’s branch?
What is the military member’s home state of record?
Is the military member stationed or assigned to Georgia?
I understand that as a Darton State College student , I may be photographed during events held on campus. I agree that my image may be published and distributed
in whole or in part for education, instruction, or promotional purposes in print or over open broadcast, cable, audiovisual, radio, closed-circuit exhibition, or
computer link. Said work will become the sole property of Darton State College, and I release Darton State College from all claims based on said work.
I understand that any material false statements made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance
with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a ne of not
more than $1,000 or by imprisonment for not less than one nor more than ve years, or both, subject me to prosecution in a court of law. Additionally, I further
understand that any such false statement may subject me to immediate dismissal from the institution.
Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
Signature: Date:
Ofce of Admissions - (229) 317-6859 • (866) 775-1214
Information and Instructions - Pleasetypeorprintlegiblyinink.
4
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03 Admissions Application

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Completed 17 November 2019

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