Expected Date of Entrance: Year: Semester: Fall Spring Summer
ETSU ID #: Date of Birth:
Name:
Permanent Legal Address and Contact Information:
Street Address City State Zip Code
E-mail Area Code - Telephone
CLASSIFICATION ( Check only one ):
Degree Seeking Student
Visiting Student
Undergraduate Special
Second Undergraduate Degree
ETSU major Concentration (MUST be listed for second undergraduate degrees)
HAVE YOU EVER BEEN CONVICTED OF A FELONY? Yes No
Do you have felony charges pending? Yes No
Are you required to register as a sex offender? Yes No
High School: Graduation Year:
PAST / CURRENT COLLEGE ENROLLMENT
NAME OF SCHOOL
By: Date:
month day year
Last First Middle
UPDATE FORM
E-mail: admissions@etsu.edu
Phone: 423-439-4213
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