Fill - Free fillable APPLICATION For Undergraduate Admission (El Paso Community College) PDF form

APPLICATION

For Undergraduate Admission to

THE UNIVERSITY OF TEXAS AT EL PASO

EL PASO COMMUNITY COLLEGE

This application is for citizens and permanent residents of the United States

ADMISSION DATES

FALL SPRING SUMMER

Application Priority Date May 1 Oct 1 March 1

Document Due Date July 1 Nov 30 April 30

Registration Begins June October March

Classes Begin August January May

Application Fee

There is no application fee to apply by the Priority Date. All required documents must be received before the Document Due Date. All documents

submitted become property of the university/college. Applications submitted after the Priority Date must pay a $15 late fee. Payment of the late

fee does not guarantee admission to the university/college.

To Apply to UTEP - Submit your completed application, ofcial transcripts and test scores to: Ofce of Admissions and Recruitment,

University of Texas at El Paso, 500 W. University Ave., 102 Academic Services Bldg., El Paso, Texas 79968-0510

To Apply to EPCC - Submit your completed application, ofcial transcripts and test scores to: Admissions, El Paso Community College,

Box 20500, El Paso, TX 79998

I hereby authorize the University of Texas at El Paso and El Paso Community College to share/exchange enrollment information

for the purpose of determining my eligibility for admission. Yes o No o

I currently attend UTEP o I currently attend EPCC o

I am interested in attending: Year Entering Term

o UTEP 200 Fall o Spring o Summer I o

Are you a veteran of the U.S. Armed Forces? Yes No Wintermester o Maymester o Summer II o

Do you plan to complete a bachelor’s degree at UTEP? Yes o No o

o El Paso Community College 200 Fall o Spring o Summer I o

Summer II o

1. Full Legal Name

Last/Family Name First Name Middle Name Sufx (Jr., Sr., III)

Other names that may appear on your academic records:

Last First Middle

(Proof of name change must be submitted if current name is different from names appearing on your academic records.)

2. Social Security Number - -

3. Current Mailing Address (P.O. Box acceptable)

Number Street Apartment

City County

( )

State Zip Country (if other than U.S.) Area Code Telephone

Please use blue or black ink.

To comply with federal and/or state statutes,

Social Security number disclosure is required of

all students except those international students

who do not have a Social Security number. You

will be assigned a unique EPCC/UTEP ID number

for identication purposes. Your ID number will be

used for all ofcial academic and business

transactions on campus.

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4. Permanent Mailing Address (Physical address only, no P.O. Box)

Number Street Apartment

City County State Zip

( )

Country (if other than U.S.) Area Code Telephone

5. E-mail Address 6. Gender Male o Female o

7. Birth Date 8. Birth Place

MM/DD/YYYY

9. Ethnic Background Please check the group that best describes your ethnic background. Choosing a group is voluntary and will be used in a

non-discriminatory manner, consistent with applicable civil rights laws. This information is gathered for federal and/or state law reporting purposes

only and will not be used in admission or scholarship decisions.

o African American/Black, Non-Hispanic o Hispanic/Latino o American Indian/Alaskan Native

o White, Non-Hispanic o Asian/Pacic Islander o Other

10. Are you a United States Citizen? Yes o No o ; If no are you a Permanent Resident in the U.S.? Yes o No o

11. High School Attended

City/State

Expected Graduation Date Month Year

Will you attend high school while enrolled at EPCC? Yes o No o

12. The GED (Test of General Education Development) is required of individuals who did not complete high school.)

Have you taken the GED? Yes o No o English o Spanish o

Date Testing Location

Testing Center City State

13. Dual Credit If you took dual credit courses while in high school then complete the information below. Submit ofcial transcripts from each

college or university attended.*

College or University State Dates Attended Degree/Credit Awarded

14. Previous College Have you ever attended another college or university? Yes o No o

If Yes, complete the information below. Submit ofcial transcripts from each college or university attended.*

College or University State Dates Attended Degree/Credit Awarded

14a. Are you currently on Academic Suspension from another college or university? Yes o No o

14b. Are your records currently on hold at another college or university? Yes o No o

* You must submit ofcial transcripts from each college or university attended. Failure to submit complete, accurate information is grounds for

rejection of an application, withdrawal of any offer of acceptance, cancellation of enrollment, denial of credit, or appropriate disciplinary action.

15. Education Goal Indicate your purpose for attending:

o Associate’s degree

o Certicate

o Earn credits for transfer to another institution

o Career enhancement

o Personal enrichment

16. Student Type Indicate your appropriate status:

o Freshman – no previous college attendance

o Transfer – previous college attendance

o Second undergraduate degree

o Returning to UTEP – previous UTEP attendance with no transfer work

o Returning to UTEP – previous UTEP attendance with new transfer work

o Transient or summer guest

17. Major Indicate the academic area you plan to study.

If attending UTEP

Refer to inserted majors table or to the UTEP Catalog online: http: //www.utep.edu/catalogs

If attending EPCC

Refer to EPCC Catalog for major and/or area of concentration

Core Residency Questions

Texas Higher Education Coordinating Board rule 21.731 requires each student applying to enroll at an institution to respond to a set of core

residency questions for the purpose of determining the student’s eligibility for classication as a Texas resident.

PART A Previous Enrollment. For all students.

1. During the 12 months prior to the term for which you are applying, did you attend a public college or university in Texas in a fall or spring term?

o Yes o No

If you answered “no” continue on to Part B.

If you answered “yes” complete questions 2-5.

2. What Texas public institution did you last attend? (Give full name, no initials.)

3. In which terms were you last enrolled? (check all that apply)

o Fall 200 o Spring 200

4. During your last semester at a Texas public institution, did you pay resident (in-state) or nonresident (out-of-state) tuition in your last term or

semester at that institution?

o Resident (in-state) o Nonresident (out-of-state) o Unknown

5. If you paid in-state tuition at your last institution, was it because you were a resident or because you were classied as a nonresident who

received a waiver?

o Resident o Nonresident with a waiver o Unknown

IMPORTANT: If you were enrolled at a Texas public institution during a fall or spring of the semester within the previous 12 months and were

classied as a Texas resident, skip to Part H, sign and date this form and submit it to your institution. Otherwise, please proceed to Part B.

PART B Residency Claim

Are you a resident of Texas? o Yes o No

If you answered “yes” continue to Part C. If you answered “no” complete the following question and continue to Part H.

Of what state or country are you a resident?

If you are uncertain, continue to Part C.

PART C Acquisition of High School Diploma or GED

1a. Did you or will you graduate from high school or complete a GED in TX? o Yes o No

1b. If you have or will graduate from high school, what is the name and city of the school?

2. Did you or will you live in TX the 36 months leading up to high school graduation or completion of the GED? o Yes o No

3. When you begin the semester for which you are applying, will you have lived in TX for the previous 12 months? o Yes o No

4. Are you a U.S. Citizen or Permanent Resident? o Yes o No

Instructions to Part C:

• If you answered “no” to question 1 or 2 or 3, continue to Part D.

• If you answered “yes” to all four questions, skip to Part H.

• If you answered “yes” to questions 1, 2 and 3, but “no” to question 4, an Afdavit will be mailed to you that must be completed and returned to

the institution. Continue to Part H.

PART D Basis of Claim to Residency. TO BE COMPLETED BY EVERYONE WHO ANSWERED “NO” TO QUESTIONS 1a, 2, and 3 OF

PART C.

1. Do you le your own federal income tax as an independent tax payer? o Yes o No

2. Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian?

o Yes o No (For eligibility to be claimed as a dependent, your parent or legal guardian must provide at least one half of your

support. A stepparent does not qualify as a parent if he/she had not adopted the student.)

3. If you answered “no” to both questions above, who provides the majority of your support?

Self, parent or guardian, other: (list)

Instructions to Part D.

• If you answered “yes” to question 1, continue to Part E.

• If you answered “yes” to question 2, skip to Part F.

• If you answered “no” to 1 and 2 and “self” to question 3, continue to Part E.

• If you answered “no” to 1 and 2 and “parent or guardian” to question 3, skip to Part F.

• If you answered “no” to 1 and 2 and “other” to question 3, skip to Part G and provide an explanation, and complete Part H.

PART E Questions for students who answered “Yes” to Question 1 or “Self” to Question 3 of PART D. Answer in white spaces.

Yes No Years Months Visa/Status

1. Are you a U.S. Citizen?

2. If not a Citizen are you a Permanent Resident of the U.S.?

3. Are you a foreign national whose application for Permanent

Resident Status has been preliminarily reviewed? (You should have

received a fee/ling receipt or Notice of Approval (I-797) from USCIS

showing your I-485 has been reviewed and has not been rejected. )

4. Are you a foreign national here with a visa or are you a Refugee,

Asylee, Parolee or here under Temporary Protective Status? If so,

indicate which.

5. Do you currently live in Texas? If you are out of state due to a

temporary assignment by your employer or temporary purpose,

please explain in Part G.

6a. If you currently live in Texas, how long have you been living here?

6b. What is your main purpose for being in the state? If for reasons

other than those listed give an explanation in Part G.

Go to College

[ ]

Establish/Maintain a home

[ ]

Work Assignment

[ ]

7. If you are a member of the U.S. military, is Texas your home of

record?

If “no” what state is listed as your military legal residence for tax

purposes on your Leave and Earning Statement?

Yes No

State

8. For the past 12 months, have you: (Check all that apply)

Yes No

a. Held the title to real property (home, land) in Texas? If yes, date acquired: ________________________

b. Owned a business in Texas? If yes, date acquired: ____________________________

c. Held a state or local license to conduct a business or practice a profession in TX?

If yes, date acquired: ________________________

9. For the past 12 months, have you: (Check all that apply)

a. Been gainfully employed in TX?

b. Received services from a social service agency that provides services to homeless persons?

10a. Are you married to a person who could answer “yes” to any part of question 8 or 9?

10b. If yes, indicate which question could be answered yes by your spouse:

Question:

10c. How long have you been married to the Texas resident?

Years Months

PART F Questions for students who answered “Parent” or “Legal Guardian” to Question 3 of PART D. Answer in white spaces.

Yes No Years Months Visa/Status

1. Is the parent or legal guardian upon whom you base your claim

of residency a U.S. Citizen?

2. If not a Citizen is the parent or legal guardian upon whom you

base your claim of residency a Permanent Resident of the U.S.?

3. Is this parent or legal guardian a foreign national whose ap-

plication for Permanent Resident Status has been preliminarily

reviewed? (He or she should have received a fee/ling receipt or

Notice of Approval (I-797) from USCIS showing your I-485 has

been reviewed and has not been rejected. )

4. Is this parent or legal guardian a foreign national here with a

visa or are a Refugee, Asylee, Parolee or here under Temporary

Protective Status? If so, indicate which.

5. Does this parent or legal guardian currently live in Texas? If

they are out of state due to a temporary assignment by their

employer or temporary purpose, please explain in Part G.

6a. If he or she is currently living in Texas, how long has he or

she been living here?

6b. What is your parent’s or legal guardian’s main purpose for

being in the state? If for reasons other than those listed give an

explanation in Part G.

Go to College

[ ]

Establish/Maintain a

home

[ ]

Work Assignment

[ ]

7. If he or she is a member of the U.S. military, is Texas his or her

home of record?

If “no” what state is listed as his or her military legal residence for

tax purposes on his or her Leave and Earning Statement?

Yes No

State

8. Do any of the following apply to your parent or guardian? (Check all that apply)

Yes No

a. Holds the title to real property (home, land) in Texas? If yes, date acquired: ________________________

b. Owns a business in Texas? If yes, date acquired: ________________________

c. Holds a state or local license to conduct a business or practice a profession in TX?

If yes, date acquired: ________________________

9. For the past 12 months, has your parent or guardian: (Check all that apply)

Yes No

a. Been gainfully employed in TX?

b. Received services from a social service agency that provides services to homeless persons?

10a. Is your parent or legal guardian married to a person who could answer “yes” to any part of question 8 or 9?

10b. If yes, indicate which question could be answered yes by your parent or guardian’s spouse:

Question:

10c. How long has your parent or guardian been married to the Texas resident?

Years Months

Part G General Comments Is there any additional information that you believe EPCC/UTEP should know in evaluating your eligibility to be

classied as a Texas resident? If so, provide it below:

PART H Certication of Residency. All students must complete this section.

I understand that ofcials of my college/university will use the information submitted on this form to determine my status for residency eligibility. I

authorize the college/university to verify the information I have provided. I agree to notify the proper ofcials of the institution of any changes in the

information provided. I certify that the information on this application is complete and correct and I understand that the submission of false information

is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment, and/or appropriate disciplinary action.

ADDITIONAL INFORMATION

Release of test scores: I authorize the sharing/exchange of enrollment information including academic history and the transfer of assessment test

scores between UTEP and EPCC as appropriate to facilitate the joint application/enrollment process. o Yes o No

If no, I understand that I may be required to complete separate application processes at each institution if I transfer or concurrently enroll.

FERPA notication: Under provisions of the Family Education Rights and Privacy Act, you may at the time you actually enroll, direct the institution

to withhold Release of Directory Information to persons not employed by the college/university. Directory Information includes your name, address,

phone number, dates of attendance, major eld of study, awards/degrees received, date of birth and most recent institution attended.

Signature: Date:

EMERGENCY CONTACT

(Optional)

Name Relationship

Address __ _________

Number Street City State Zip

Phone E-mail _________________________________________________

(Area Code) Number

Statement of Equal Educational Opportunity

With respect to the admission and education of students; with respect to the availability of student loans, grants, scholarships and job opportunities; with respect to the student and faculty

housing situated on premises owned or occupied by the institution; El Paso Community College and the University of Texas at El Paso shall not discriminate either in favor or against any

person on the basis of race, sex, religion, color, veteran status, age, national origin or disability.

Texas Government Code: Sections 552 and 559

With few exceptions, you are entitled on your request to be informed about the information El Paso Community College and the University of Texas at El Paso collect about you. Under

Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government code you

are entitled to have the institutions correct information about you that is incorrect in accordance with the procedures set forth in the University of Texas System Business Procedures

Memorandum 32. The information that the institutions collect will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas

Government code) and rules. Different types of information are kept for different periods of time. Rev: 10/2004

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