SOUTHERN UNIVERSITY A&M COLLEGE
DIVISION OF CONTINUING EDUCATION
APPLICATION FOR ADMISSION
Directions: Read carefully before completing application.
Application must be accompanied by a $35.00 application fee.
(NO CASH or PERSONAL CHECKS ACCEPTED. MONEY ORDERS ONLY)
Social Security Number
Semester entering
Fall
Spring ________Year
Summer
Today’s date
First name
Middle name
Last name
Address
City
State
Zip Code
Parish/County
Emergency phone number
Emergency contact
E-mail address
Gender
Male
Female
Veteran
Yes
No
Marital status
Single
Married
Race
American or Alaskan
native
Hispanic
Asian or Pacific Islander
White/Caucasian
Black/African American
Other
Louisiana
resident
Non Louisiana
resident
International
student
Citizenship
United States
U.S.
Resident
Alien
Non-citizen
Religious Preference
Indicate Religious Preferenced
Name of High School
Address
City/State/Parish
Parish
Date of Graduation
GED diploma
Yes
No
Have you attended Southern University?
Yes If yes, Last semester enrolled ______________
No
Have you attended any other college or university?
Yes
No
If yes, you must list below all colleges or universities attended. A transcript must be submitted from each institution and/or high
school or both before full admission to SUBR is complete
.
College or university Location Dates attended Date graduated Type of Degree
College or university Location Dates attended Date graduated Type of Degree
College or university Location Dates attended Date graduated Type of Degree
What is your objective at SUBR ?
Classes only; no degree
Teacher Certification
Distance Learning
Non-credit courses
I certify the information given is complete and accurate to the best of my knowledge. I understand that failure
to provide complete and accurate information is the basis for rejection of application or suspension.
Signature: ______________________________________________ Date: ____________________________
Please Type or Print Mail to: Division of Continuing Education P.O. Box 9772 Baton Rouge, LA 70813
click to sign
signature
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