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Fillable - Adult Undergrad Application 2019 (University of Northwestern, St. Paul)

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07042016
Adult Undergraduate
Application for Admission
Applicant Information
LEGAL FIRST NAME FULL MIDDLE NAME LAST NAME
PREFERRED FIRST NAME MAIDEN NAME PREVIOUS NAME(S)
MALE FEMALE / /
SOCIAL SECURITY NUMBER BIRTHDATE (MM/DD/YYYY)
STREET CITY STATE ZIP
( )
PREFERRED PHONE CELL WORK HOME E-MAIL
This e-mail address will be used to send transfer credit evaluations, confidential user name and password, and other official UNW communication
during the enrollment process.
EMPLOYER START DATE POSITION/TITLE
PREFERRED ENROLLMENT DATE:  FALL / SEPTEMBER (YEAR)  SPRING / JANUARY (YEAR)  SUMMER / MAY (YEAR)
INTENDED MAJOR
: PREFERRED FORMAT: BLENDED/ON SITE  ONLINE
If interested in a minor or double major, which area of study:
Previous Education
NAME OF HIGH SCHOOL CITY/STATE YEAR OF COMPLETION
Please list all postsecondary institutions you have attended, whether you earned credit or not. You must submit official transcripts from each
institution. Attach additional sheet if needed.
DEGREE RECEIVED
NAME OF INSTITUTION DATES ATTENDED/REGISTERED o YES o NO IF YES, LIST
DEGREE RECEIVED
NAME OF INSTITUTION DATES ATTENDED/REGISTERED o YES o NO IF YES, LIST
DEGREE RECEIVED
NAME OF INSTITUTION DATES ATTENDED/REGISTERED o YES o NO IF YES, LIST
DEGREE RECEIVED
NAME OF INSTITUTION DATES ATTENDED/REGISTERED o YES o NO IF YES, LIST
1 of 4
At this time, please provide this over the phone instead of via email.
Psychology (Bachelor's Degree)
None
07042016
Financial Information
Will you be receiving tuition assistance from your employer or other outside scholarships? YES NO
Anticipated annual benefit amount: $
Please list any immediate family members who are currently enrolled at Northwestern:
NAME RELATIONSHIP
Minnesota residents: have you lived here for 12 or more months? 
YES NO
If less than 12 months, when did you move to Minnesota?
MONTH/YEAR
Previous state of residence
Background
Are you a U.S. citizen?
YES NO
Have you ever been convicted of a felony?
YES NO
Are you currently active in the U.S. military or a
veteran? YES NO
(If yes, attach Duty Orders or a copy of form
DD214)
Have you ever been dismissed from school, college, or work or been convicted of a crime? If yes, explain:
Ethnicity and Race
These questions comply with the U.S. Department of Education’s
standards for ethnic and racial data collection. Providing the information
below is voluntary and will not be used in a discriminatory manner.
Race: Please check any or all that apply.
American Indian or Alaska Native 
Asian
Black or African-American 
East Indian
Native Hawaiian or other Pacific Islander
White Other:
Ethnicity: Are you Hispanic or Latino?
YES  NO
COUNTRY OF CITIZENSHIP (IF NOT THE U.S.):
COUNTRY OF BIRTH:
If not a U.S. citizen, attach one of the following: copy of green card, alien resident card, I-9 or student visa.
Personal Faith Statement
Have you entrusted yourself to Jesus Christ as Lord and Savior? YES NO
CHURCH NAME DENOMINATION CITY/STATE
Northwestern believes that the Bible alone is the final authority and standard in all matters of faith and personal conduct.
Do you agree? I AGREE I DO NOT AGREE I’M NOT SURE Comments:
Do you currently have information posted in any public domain (websites, blogs, etc.) that would contradict anything in the Declaration of Christian
Community (unwsp.edu/dcc) or anything you are including in this application? YES NO If yes, please explain.
2 of 4
Essay
Please use the space provided to write two paragraphs that tell about your personal and professional goals and how you see Christ working in your
life.
3 of 4
07042016
University of Northwestern – St. Paul is accredited by the Higher Learning Commission of the North Central Association of Colleges and Schools
(ncahigherlearningcommission.org, 312-263-0456). University of Northwestern is registered as a private institution with the Minnesota Office of Higher Education pursuant to
sections 136A.71. Registration is not an endorsement of the institution. Credits earned at the institution may not transfer to all other institutions.
Northwestern Connection
Please tell us how you first heard about Northwestern’s Adult Undergraduate program.
What one factor was most influential in your decision to apply to Northwestern?
4 of 4
Applicant Signature
I affirm with my signature that I have read the Declaration of Christian Community. If I am accepted and subsequently enroll as a student,
I will gladly adhere to its spirit and standards and will seek to be a positive, active member of the University of Northwestern – St. Paul
community.
I affirm that all information contained in this application, including any attached documentation containing personal information that I
have provided, is accurate, complete and honestly presented.
I affirm that I have accurately represented my previous academic experience.
SIGNATURE PRINT NAME DATE
Applicants who demonstrate potential to positively influence the Northwestern community will be shown preference in the admission
process. The Admission Committee reserves the right to assess all application materials for this purpose.
ADULT UNDERGRADUATE
3003 SNELLING AVENUE NORTH
ST. PAUL, MN 55113-1598
UNWSP.EDU/FIND-YOUR-DEGREE/
ADULT-UNDERGRADUATE
651-631-5200 | 888-362-8715
Click to Submit Application
click to sign
signature
click to edit
07042016
Declaration of Christian Community
WE WILL HONOR CHRIST
We at University of Northwestern – St. Paul and Northwestern Media
have decided that whatever we do, for as long as we choose to be
involved in this community, as students, teachers, administrators, on
the board of trustees, as employees in the university or the media
ministry, wherever we choose to live, our relationship to Jesus Christ and
commitment to obey God’s Word will be at the very center. This promise
to God and to each other is what binds us together and sets us apart
from the world. We believe that it is our duty, honor and delight to live
under the Lordship of Christ, to study His Holy Scriptures, to reach all
nations with the gospel of salvation through faith in Christ and teach
them how to be disciples, to participate in the relentless and joyous
pursuit of His truth, and we believe it is our privilege and responsibility to
live in community with other believers who feel the same.
WE WILL STRIVE FOR CHRIST-CENTERED COMMUNITY
We, as members of Northwestern’s Christ-centered community, will
strive to love our God and each other as He loves us (Matt. 22:37–39):
with kindness, mercy, faithfulness, gentleness, grace, patience and
perseverance (Gal. 5:22, 23; Jas. 1:4). We will love what is good and abhor
what is evil (Rom. 12:9). We will seek righteousness and justice. We are
willing to be as servants to each other. We will encourage and support
each other (Heb. 10:24). We value the passionate exchange of ideas, but
we will strive to resolve conflicts with humility, kindness, mutual respect
and Christ-like love (Col. 3:13, 14). We are to be faithful witnesses to
the gospel (1 Pet. 3:15), people of integrity, practicing good works and
self-control, with lives filled with prayer, joy and thanksgiving (1 Thess.
5:15 –22).
AS EMPLOYEES, WE WILL SEEK CHRIST-CENTERED
CO M MU NIT Y
As employees of Northwestern, we agree to put Jesus Christ at the
center of our lives and work. We will strive to live and work in Christ-like
community, dedicated to each other and our God, for the betterment of
His Kingdom, His people and Northwestern. We will respect each other:
our peers, our students, our listeners, those to whom we answer and
those who answer to us (1 Pet. 2:17), knowing that Christ has brought us
together to further His plan and for His glory. We will value individuality
and work for commonality (Phil. 2:2). We will strive to protect the
weakest members of our community (Psa. 41:1). We voluntarily abstain
from certain activities that might draw us or others away from God (1
Cor. 8:9–13; Gal. 5:19–21), particularly on behalf of those students and
listeners who are new to their freedom and have placed themselves in
our environment or in our care.
AS LEADERS, WE WILL SEEK CHRIST-CENTERED
COMMUNITY
As leaders in the Northwestern community, whether serving as a
manager, director, department head, vice president, cabinet member,
president or board member, we will be prayerful in our decisions,
receptive to the needs of the community, dedicated to the present
and future welfare of Northwestern. We will be good stewards of the
responsibilities that have been temporarily placed in our care, seek God’s
wisdom with humility and a servant heart, and pursue excellence with
compassion and Christ-like love (Col. 3:12).
AS FACULTY MEMBERS, WE WILL SEEK CHRIST-CENTERED
COMMUNITY
As faculty members, we dedicate ourselves to our students and to each
other in the community for the glory of God and the relentless and
joyous pursuit of His truth. We will strive for excellence as teachers
and as scholars. We will be good stewards of the responsibilities of our
positions, building up and encouraging those around us (1 Thess. 5:11),
and we will be faithful mentors and instructors to the students whom
God has temporarily entrusted to our care.
AS STUDENTS, WE WILL SEEK CHRIST-CENTERED
COMMUNITY
As students at University of Northwestern, we will strive to create an
atmosphere of Christ-centered community. We will put our relationship
to Jesus Christ at the center of our lives and our studies (Gal. 2:20). As
students, we agree to watch out for each other, support each other,
encourage each other, push ourselves and each other to work our
hardest, to live with integrity, to pursue God’s truth, to do our very best
for the benefit of ourselves and other students, the benefit of University
of Northwestern, its faculty and staff, and for the glory of our Lord and
Savior Jesus Christ (Col. 3:17). In our language and our actions, we will
honor and respect those in leadership positions. We will consider the
weaknesses of others as important as our own freedoms or personal
strengths for the greater good (Rom. 14:19–21), acknowledging that
each student comes to Northwestern from a different place in his or
her spiritual journey. We agree to protect the weaker members of the
community, even ourselves. We will depend on each other and be
dependable. We understand that many rules and guidelines at University
of Northwestern, instituted and followed by the whole community for the
safety and benefit of all, were created to instruct and steer us into right
choices, foster true Christ-centered community during our years here,
and teach us how to spread Christ-centered community to others.
NORTHWESTERN WILL BE SET APART
We pledge to set ourselves apart as a community of believers for the
glory of God. We will hold ourselves accountable to each other, so that,
with the sustaining support of the Holy Spirit, we will stand together
against the dangers of our fallen world and our own sinful impulses.
We stand together against all that the Bible clearly condemns: greed and
materialism, dishonesty (plagiarism included), prejudice, social injustice,
impurity and debauchery, casual and disrespectful use of the name of the
Lord, drunkenness, violent behavior, occult practices, hatred, jealousy,
pride and discord, immodesty in dress or behavior, murder/homicide
(including abortion), slander, gossip, gluttony, vulgar or obscene
language and any activities that are illegal (Col. 3:5–11; Gal. 5: 19–21; 1
Cor. 6:9–10).
We support the sanctity of marriage (Ephesians 5, Hebrews 13:4). We
define marriage as being a covenant between one man and one woman
(Gen. 2:21-24; Matt. 19:4-5). We believe in honoring the holy sexual union
within the context of that covenant (Hebrews 13:4). Believing that God
redeems and restores through life in Christ, we walk alongside those that
are seeking to overcome sexual sin (Romans 6-8; Galatians 6:2).
Save this page for future reference
07042016
Declaration of Christian Community, page 2 of 2
As followers of Christ, we turn from sexual immorality in its many forms
including but not limited to: pornography, pre-marital sexual relations,
adultery, and same sex romantic intimacy and/or sexual relations. We
come alongside those experiencing same sex attractions who choose
to honor Christ by not pursuing those attractions, just as we come
alongside all individuals who seek to live in purity before the Lord (Col.
3:5; Gal. 5:19-21; Rom. 1:21-27; 1 Cor. 6:9-10).
We believe we are created by God in His image as two distinct sexes:
male and female (Gen. 1:26-28; Matt. 19:4-5). We believe that each
person glorifies God and affirms His infinite holiness and wisdom by
living in alignment with his or her birth sex. While we acknowledge there
may be confusion and brokenness for some individuals in this area, we
do not affirm or support transgender identity or expression. Instead, we
place our faith and trust in God’s redemptive plan.
We also stand together to better carry each other’s burdens (Rom.
14:19–21). We understand that sometimes, for the cause of a stronger,
safer society and workplace and the gentle support of each other, we are
called to exercise our freedom to abstain from activities that might cause
others to fall away.
We stand together to protect our community from any illegal or
dangerously addictive substances, knowing they can destroy the lives of
all who become entangled with them. The sale, posses¬sion, and use
of non-medicinal drugs and the recreational use and abuse of over-the-
counter and pharmaceutical drugs are strictly prohibited.
We do not care to participate in society’s casual acceptance of gambling.
Any games of chance where money or valuables are risked on the
outcome will not be promoted and should be avoided by all members.
The Bible clearly demonstrates that throughout the cultures of the Old
and New Testaments, the moderate use of alcohol is accepted and
prevalent (e.g. 1 Tim. 5:23; Isa. 55:1). In our contemporary American
culture, however, the abuse of alcohol has been the cause of tremendous
heartache and tragedy, particularly in the hands of the young, and we
will stand together as a community to make sure that the use of alcohol
will not be promoted, nor its abuse tolerated at Northwestern (cf. Prov.
23:20; Eph. 5:18).
Likewise, Northwestern will not participate in society’s casual
acceptance of tobacco, a substance whose highly addictive qualities
and life-threatening potential have been well documented. Although
the Bible does not deal directly with the use of tobacco, the Lord clearly
expects His children to value their own lives as well as protect the lives
of others (cf. Gen. 9:6; John 15:13).
We agree and accept that Northwestern and all its functions will be
alcohol and tobacco free. This includes on or around all campus
properties, owned or leased, all university vehicles, whether on or off
campus and all Northwestern events, wherever they may be held.
As members of the Northwestern community who are not traditional
undergraduates, we will refrain from the consumption of any tobacco
products or alcoholic beverages at any Northwestern-related event or
gathering, formal or informal, and/or at any public or private setting
in which any traditional undergraduate members are or are likely to be
present.
If we are traditional undergraduate students, we will refrain from the
consumption of alcoholic beverages and tobacco products.
We agree to abide by the student and employee handbooks for specific
guidelines, information on special provisions (for example, the
sacramental use of wine) and all related disciplinary procedures.
WE WILL EXERCISE RESPONSIBLE FREEDOM
As faithful followers of Christ and as members of Northwestern, we
will exercise our God-given freedoms responsibly, with thought¬ful
discretion. In all matters of entertainment and culture, we will keep as
a guide the words of Philippians 4:8: “Finally, Brothers, whatever is true,
whatever is noble, whatever is right, whatever is pure, whatever is lovely,
whatever is admirable—if anything is excellent or praiseworthy—think
about such things.”
We agree not to participate in any kind of entertainment that could
be considered immodest, prurient, or harmfully violent (cf. Gal.
5:19-23). We will seek the guidance of the Holy Spirit and hold each
other accountable (Matt. 18:15–19) when participating in all forms of
amusements and entertainment, such as television, music, video, video
games, movies, Internet, concerts and dancing.
A COMMUNITY WITHOUT BORDERS
We seek a joyous and enriching community, set apart for the glory of
God, inhabited by people who treat each other with Christ-like love,
humility and kindness, working together for the benefit of Northwestern
in the pursuit of God’s truth and the spread of His gospel.
As long as I enjoy the privilege of membership, wherever I am in the
world, I will strive to represent my community with integrity. I will
remember that I am, above all, an ambassador of Christ and His
Kingdom. Officially, I will consider myself a member of the University
of Northwestern – St. Paul and/or Northwestern Media community for
the entire length of my em¬ployment, my leadership role, and/or my
association as a student.
THIS IS MY COVENANT
This document is a formal statement of individual commitment and
shared purpose. I understand that, if I am accepted into or employed
by University of Northwestern or Northwestern Media, I will be a
productive member of the Northwestern community and I will choose to
live by the principles and expectations contained in this Declaration of
Christian Community. I also understand that failure to live within these
guidelines can result in disciplinary action up to and including dismissal.
I want to be a member of this Christ-centered community. I will follow
these guidelines with integrity, and I want to experience the privileges
and benefits that, by God’s grace, each community member hopes and
expects to enjoy.
3003 SNELLING AVENUE NORTH
ST. PAUL, MN 55113-1598
651-631-5200
888-362-8715
ADULT UNDERGRADUATE
ADMISSIONS
AUADMISSIONS@UNWSP.EDU
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Completed 15 July 2020

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