Fillable Personal Information City State Zip code Country Complete (Saint Xavier University)

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Personal Information City State Zip code Country Complete (Saint Xavier University)

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CHICAGO, IL
3700 West 103
rd
Street • Chicago, IL 60655
Phone (800) 462-9288 • Fax (773) 298-3076
ORLAND PARK, IL
18230 Orland Parkway • Orland Park, IL 60655
Phone (708) 802-6200 • Fax (708) 802-6202
Personal Information
Social Security Number Gender M F Date of birth
month day year
Name
last/family first nickname middle maiden
Address
City State Zip code Country
Mailing address, if different_
street city state zip country
Home phone Cell phone Business phone
(area code) (area code) (area code)
Would you like to receive text messages from SXU? Yes No Cell phone provider
E-mail address______________________________________________ T-shirt size: Medium Large X-large
Enrollment Plans
Date of entrance: August 20
January 20
Summer 20
year year year
Location: Chicago Orland Park Other______________________________________________
I will be a: Freshman Transfer Adult (
age 23 and over)
Enrolling: Full time (12+ semester hours) Part time (6-11 semester hours) Part time (1-5 semester hours)
Do you plan to live on campus? (Chicago only and age 22 a
nd younger) Yes No
Major program of study at SXU
Please list pre-professional or career interests (ex: Pre-Law, Pre-Medicine, Teaching, Management):
Do your parent(s) (natural or adoptive) have a bachelor’s degree? Yes No
Have relative(s) of yours attended SXU? Yes No If yes:
name relationship last year attended
Citizenship
U.S. citizen
Permanent resident Country of citizenship Alien Registration Number
I am not a U.S. citizen or permanent resident Country of citizenship Visa Status
Are
you a United States Veteran? Yes No
Are either of your parents a United States Veteran? Yes No
Ethnicity (Optional)
Are you Hispanic or Latino descent? Yes No
In addition, select one or more of the following racial categories to describe yourself:
American/Alaska Native Asian Black or African American
Hawaiian/Pacific Islander White Other
Religion (Optional)
Catholic Islamic Jewish Orthodox Protestant Other
Language (Optional)
Is English the primary language spoken in your home? Yes No
If no, please indicate primary language:
Application for Undergraduate Admission
Complete and return to the Office of Admission
by mail or email at admission@sxu.edu
Education
Current High School - List your high school and include the date of graduation.
high school city state graduation date
High school cumulative grade point average /4.0 ACT composite score SAT total score
If you have not yet taken the ACT/SAT, when do you plan to do so? / (SXU school codes: ACT 1134, SAT 1708)
Have you participated in the AVID program in your high school? Yes No
Have you participated in other college preparation or mentoring programs in your high school or community? Yes No
If yes, please list.
Have you ever been a subject of a major disciplinary procedure at a school? Yes No (If yes, please see Personal
Statement/Recommendations.)
College History - List all colleges and universities attended (most recent first) and include the dates of attendance/graduation
and any degrees earned. If more than three colleges, please use separate sheet to report complete list.
college/university
city
state
dates attended
hours
GPA
college/university
city
state
dates attended
hours
GPA
college/university
city
state
dates attended
hours
GPA
Personal Statement/Recommendations
For consideration into the Nursing Program, you are required to write a personal essay. Attach a separate sheet describing, in
a typed essay, why you would like to become a nurse, the quality of your academic performance and how you plan to be
successful at Saint Xavier University.
For all other programs. While we do not require an application essay or recommendations, the Admission Committee
encourages the submission of either a short writing sample or an essay addressing your educational history, particularly if it
would be to your benefit to explain your previous academic record. In particular, if you were ever suspended from a school,
a written explanation is required. We reserve the right to ask for an essay or personal recommendation at a later date, should
they offer help to the committee’s decision.
For High School Students Only
Please request official high school transcript and ACT or SAT score be sent directly to the Office of Admission.
Name of Parent or Guardian_
Street Address (if different than yours)
City State Zip code Country
Parent/Guardian E-mail address Relationship
Recommended for High School Students
Attach a separate sheet listing any academic honors, work history, and extracurricular activities.
For Transfer and Adult Students Only
Please request that official transcripts from each college and/or university you have attended be sent directly to the Office of
Admission at SXU. If you plan to major in nursing or the sciences or if you have earned less than 30 semester hours of college
credit, you must request an official high school transcript be sent directly to the Office of Admission as well. All transfer and
adult nursing applicants are required to submit a TEAS test score.
Certification
Have you ever been convicted of a crime? Yes No (If yes, please use personal statement to describe circumstances.)
Have you ever been subject to major disciplinary action from a school? Yes No (If yes, please use personal statement to
describe circumstances.)
I understand that withholding information on this application or giving false information may make me ineligible for
admission to Saint Xavier University or subject to dismissal. I have read this application and certify that the statements I have
made are correct and complete. Please sign this application below by typing your name and date in the space provided.
Signature Date
08/16
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Completed 24 July 2020

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