Fillable Ethnic Origin (optional) Black White Hispanic Native American/American (Dillard University)

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Ethnic Origin (optional) Black White Hispanic Native American/American (Dillard University)

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U.S.A. forms for Dillard University

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Application for Admission
Name __________________________________________________________________________________________________________________
Last
First
Middle
Date of Birth ______ /______ /______ Gender: Male Female
Month Day Year
Marital Status (optional)
Ethnic Origin (optional) Black White Hispanic Native American/American Indian
Asian Pacic Islander Middle Eastern
Single
Married
Divorced
Widowed
___________________________________________________________________________________________________________________
Mailing Address
__________________________________________________________________________________________________________
Parish (Louisiana Residents) ________________________________________ Email Address ____________________________________________
Mobile Phone Number ____________________________________________ Telephone Number________________________________________
Street City State Zip
Academic Information
Social Security Number
Enrollment Information
I plan to enroll: Year _________ Fall (August) Spring (January) Summer (June)
I plan to live: On-Campus Off-Campus
Will you be a: Freshman Transfer International Consortium Non-Degree Seeking Readmit
Are you applying to the Evening Program? Yes No
Name of high school you currently attend (or graduated from) No abbreviations
School Name City State Graduation Year
Have you ever attended any college or university before? Yes No
Did you take any Dual-Enrollment courses? Yes No
List all Colleges/Universities you have attended (or graduated from)
From To
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
From To
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
If no, country of Citizenship ____________________________________________________________Are you a U.S. Citizen? Yes No
Have you received your General Equivalency Diploma (GED) or HiSet? Yes No If yes, what year did you receive it? ___________
From To
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Will you be requesting nancial aid? Yes No
Dillard University accepts the following fee waivers:
NACAC
College Board
Free/Reduced Lunch
ACT Fee Waiver
Letter of Financial Hardship
Each One Reach One
Campus Tour/Event/On-Site Admissions
Application Fees:
Freshmen and Transfer Applicants: $36.00
Re-admit applicants: $26.00
International Applicants: $55.00
Submit this application, along with your high school or college transcript, a copy of your ACT/SAT test score and enclose a money order or check for the appropriate application fee to:
Ofce of Recruitment, Admissions and Programming
2601 Gentilly Blvd.
New Orleans, Louisiana 70122
(504) 816-4670 or (800) 216-6637
Fax (504) 816-4895
admissions@dillard.edu
www.dillard.edu/apply
Majors: Check only one box below for your intended major
Accounting
Biology
Business Administration
International Business
Management
Marketing
Chemistry
Computer Science
Criminal Justice
English
Film
Financial Economics
Psychology
Public Health
Community Health
Health Systems Management
Health Sciences
Social Work
Theatre
Performance
Technology
Undecided
Urban Studies and Public Policy
Visual Arts
Mass Communication
Multimedia Journalism
Public Relations
Mathematics and Actuarial Science
Music
Music Industry
Voice Performance
Musical Theatre
Nursing
Physics
Medical Physics
Pre-Engineering
Political Science
United Methodist Church United Church of Christ Other:________________________________________________________________
If United Methodist or United Church of Christ please give the name of your church:
_________________________________________________________________________ City/State__________________________________
Is your parent a United Methodist or United Church of Christ pastor? Yes No
If yes, Name of Church:________________________________________________________ City/State__________________________________
Disciplinary Data
Have you ever been convicted or pled guilty to a crime (a felony) that might be punishable by imprisonment? Yes No
If yes, attach a complete explanation giving date, name of court, nature of offense, status of charge, penalty imposed, if any, or other disposition.
Have you ever been suspended or dismissed from any college or university for scholastic or disciplinary reasons? Yes No
If yes, give name of institution, date, and reason for this action.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Louisiana Residents Initial here ___________________ I do hereby authorize Louisiana post-secondary education access to my academic records.
I certify that the information given in this application is complete and accurate. I understand that giving false information will disqualify my application for admission to
Dillard University.
Applicant’s Signature______________________________________________________ Date ________________________
Dillard University does not discriminate in admissions, educational programs or employment on the basis of race, color, religion, sex, sexual orientation, national origin, age disability, or veteran/Reserve/National
Guard status and prohibits such discrimination by its students, faculty and staff. Students, faculty and staff are assured of participation in University programs and use of facilities without such discrimination.
Accommodations for Students with Disabilities
The University complies with the Americans with Disabilities (ADA) Amendment Act of 2008 and Section 504 of the Rehabilitation Act of 1973. Requests for accommodation or auxiliary services can be made
by contacting: the Office of the Office of Disability Services, New Orleans, LA, 70122, (504) 816-4714 (voice).
Religious Affiliation
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Ethnic Origin (optional) Black White Hispanic Native AmericanAmerican (Dillard University)

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Completed 19 August 2020

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