Return to:
The Graduate School
211 Tillman Hall
Rock Hill, SC 29733
gradschool@winthrop.edu
(FAX) 803/323-2292
APPLICATI
ON FOR TRANSIENT GRADUATE ADMISSION
Please complete this application and return with a nonrefundable $50 application fee to the address listed above. Applications are valid for one year only.
Applications submitted without the fee will be returned to the applicant without being processed.
PLEASE PRINT OR TYPE
TERM AP
PLYING: FALL 20 ____ SEX: ____________________
SPRING 20____ MALE ____ Social Security Number
SUMMER 20____ FEMALE____ ____________________
Birth Date
_____________________________________________________________________________________________________________________
Name—Last Fi
rst Middle Second Middle (If Applicable)
_____________________________________________________________________________________________________________________
Name on previous academic records, if different Email Address
________________________________________________________________________________________________(_________)___________
Permanent Mailing Address – Street/
P.O. Box City State Zip Phone
_________ _
_______________________________________________________________________ ____________________________________
CURRENT EMPLOYER/ADDRESS PHONE
State of Legal Residence_________________________ Country___________________ Country of Birth______________
All applicants who claim South Carolina Residency for tuition and fee purposes are required to complete the South Carolina residency form.
Citizenship
(Please Check One)
USA
USA Permanent Resident, Citizen of ____________________ _____________ Alien Registration Number_____________________
REQUIRED: Provide copy of green card.
Foreign, Citizen of ____________________________________________
If you are not a U.S. citizen or immigrant, what is your current visa classification _____________________________________
Please attach a copy of your current visa.
Are you certified to teach? Yes No
List colleges and universities attended, indicating degrees and dates of attendance.
I certif
y that the information contained in this application and the accompanying documents are complete and accurate to the best of my knowledge. I have
truthfully disclosed my citizenship status and understand that failure to do so will result in a violation of South Carolina immigration law. I understand that any
omission or misrepresentation of fact will constitute cause for nullification of my application or dismissal from enrollment at Winthrop.
_________
___________________________________________________________ _____________________________________________
SIGNATURE OF APPLICANT DATE
List the course(s) that you wish to take.
Call Number Course Suffix Number Title Hours
1. ______________________________________________________________________________________
2. ______________________________________________________________________________________
Please have the graduate office at your home institution complete the following statement:
The above student is a graduate
student in good standing at______________________________________________________________and is eligible to return.
___________________________________________________________ ________________________________________
SIGNATURE OF GRADUATE SCHOOL DEAN (SEAL OF
INSTITUTION R
EQUIRED) DATE
Winthrop University offers equal opportunity i
n its
employment, admissions, and educational activities. The university is governed by civil rights laws, including Title IV of the Education
Amendment of 1972 and Section 504 of the Rehabilitation Act of 1973, as amended.
COLLEGES AND
UNIVERSITIES
DEGREE AND DATE MONTH/YR.
Ethnicity (for U.S. citizens only)
How would you describe yourself? (Note: This information is optional and requested for federal and state reporting purposes. All applicants are
considered without reference to sex, creed, or race.) Please circle the appropriate categories
1. Are you Hispanic or Latino? Yes/No
2. What is your race? Regardless of your answer to the previous question, please indicate what you consider yourself to be:
American Indian/ Alaskan Native Black/African American White Asian Native Hawaiian/Pacific Islander
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