Fillable Application for Non-Degree Cooperative Program Admission (University of Idaho)

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Application for Non-Degree Cooperative Program Admission (University of Idaho)

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For Office Use Only
Student ID #
____________________________________
Degree Seeking: UGRD GRAD
Eligible to Register
Initials _________ Date ____________
Application for Non-Degree Cooperative Program Admission
Complete BOTH pages of this form and submit to WSU for initial processing
Washington State University, Office of the Registrar
French Ad 0346
Fax #: 509-335-7823 Phone #: 509-335-5346
SEMESTER: (choose one) Fall Spring Year: _________
WSU Student ID# ___________________________ E-mail Address: __________________________________________
Legal Name: _______________________________________________________________________________________
Last First Middle
Other and former names used: _________________________________________________________________________
Current Address: ____________________________________________________________________________________
Street City State Zip
Date of Birth: ____________________________ Current Telephone: ________________________________
Are you a U.S. Citizen? Yes No If No, Visa Type: ________________________________
Are you a Permanent Resident? Yes No Permanent Resident Card # _________________________
GENDER: (optional) Male Female
ETHNICITY/RACE: (optional) Are you Hispanic/Latino/Latina or of Spanish origin? Yes No
American Indian/Alaska Native Native Hawaiian/ Other Pacific Islander
(check all that apply) Asian White
Black/African American
PRIOR REGISTRATION:
Have you attended UI previously? No Yes Date Last Enrolled _____________ UI ID # _____________________
Release Notification:
The University of Idaho (“UI”) and Washington State University (“WSU”) will exchange information relevant to the
determination of your financial aid eligibility. WSU students may receive financial aid only from WSU. Your registered credit hours at UI
and WSU will be combined each semester to determine your enrollment level for financial aid eligibility. Credit hours must apply to your
current degree objective to be included in your enrollment for aid purposes. Transcripts will be exchanged between the UI and WSU at the
end of the semester.
Please note: WSU students participating in cooperative courses are responsible for paying UI for any special fees associated with such
courses. Tuition will be assessed by WSU. WSU students registering for non-cooperative courses are responsible for paying UI for all
tuition and fees associated with such courses. Students may not register at UI for both cooperative and non-cooperative courses in the
same term.
SIGNATURE:
In signing this form, I authorize UI officials to share my academic records, account information, and financial aid information with WSU
officials. I understanding that by signing this release, I am waiving my right to keep this information confidential under the Family Education
Rights and Privacy Act. I certify that my consent for disclosure of this information is entirely voluntary. I understand that this consent for
disclosure of information can be revoked by me in writing at any time by contacting the UI Registrar, but will not affect the information
released under my previous consent.
Signature (Required)___________________________________________________________ Date_________________
ADMISSION ADDITIONAL INFORMATION
As part of the application process, every applicant to the University of Idaho must respond to the following two questions.
Processing of your admission file will not continue until these questions have been answered. Please mail, e-mail or fax this
completed form and any required personal statements to the Admissions Office using the contact information above.
1. Have you ever been found responsible for a disciplinary violation at any educational institution you have attended
from the 9th grade forward (or the international equivalent), whether related to academic misconduct or behavioral
misconduct that resulted in disciplinary action? These actions could include, but are not limited to: reprimand,
warning, probation, suspension, removal, dismissal, or expulsion from the educational institution.
Yes
No
2. Other than minor traffic offenses (e.g., speeding, parking tickets, etc.), (1) have you ever been adjudicated guilty or
convicted, had a withheld judgment, or pleaded no contest to a misdemeanor, felony, or other crime, (2) are such
charges pending against you, or (3) have you been required to register as a sex offender by any legal authority in the
U.S. or any other country? (Note: If the criminal adjudication or conviction has been expunged, sealed, annulled,
pardoned, erased, or otherwise ordered by the court to be kept confidential, then you are not required to answer
“Yes” to this question, or provide an explanation.)
Yes
No
If you answered "Yes" to either or both questions, please submit a personal statement of the circumstances, approximate
date(s) of incident(s), and your thoughts on lessons learned from the experience. The review committee will consider this
statement in conjunction with all other application information provided when making an admission decision.
SIGNATURE
In submitting this form to the University of Idaho:
I certify that (1) all information, documentation and other supporting materials submitted in the admission process is my
own work, is factually true and accurate, and is not misleading; and (2) all documents I have submitted will become property
of the University of Idaho (UI) and will not be returned to me.
I authorize UI to communicate with any third party and any third party to communicate with UI to verify the accuracy and
authenticity of any information or document that I provide or that is provided on my behalf to UI. I authorize UI and any third
party to disclose information about me, my application, or my records as part of any such communication.
I understand that I may be subject to a range of possible actions, including but not limited to admission revocation,
expulsion, or revocation of course credit, grades, and degree, should the information I have provided be false, inaccurate, or
misleading.
I certify that I will notify the University immediately should there be any changes to the information, documentation or
other supporting material that was submitted in the admission process, including any disciplinary history.
Signature ___________________________________________________________________________________________
Printed Name ________________________________________________________________________________________
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Application for Non-Degree Cooperative Program Admission (University of Idaho)

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Completed 24 July 2020

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