2012 Summer School Bulletin - Emory College - Emory University

Visiting Student Summer Application
STUDENT INFORMATION
I plan to enroll (check all that apply): Maymester 1st session 2nd session
(May 15–June 1) (May 21–June 29) (July 2– August 10)
1. Name
2. Social Security Number
Last name First Middle Suffix
3. Under what other name might documents be received?
4. Permanent address
Street
City State Zip Telephone
5. Temporary address
6. Email address
Street
City State Zip Telephone
7. Date of birth 8. Place of birth
City/State Country
9. Citizen of what country? If not a U.S. citizen, specify type of visa
In case of an emergency, please notify
Name
Address Relationship Phone number
10. First language, if other than English ______________Language spoken in your home_______________
11. If you wish to be identified with a particular religion, please identify your faith or denomination:
12. Are you are Hispanic/Latino? Yes, Hispanic or Latino (including Spain) No
Regardless of your answer to the prior question, please indicate how you identify yourself (Check all that apply).
American Indian or Alaskan Native Native Hawaiian or other Pacific Islander
(including all Original People of the Americas) (Original Peoples)
Asian or Pacific Islander White (including Middle Eastern)
(including Indian subcontinent and Philippines)
Black or African American Two or more races
This information is voluntary; refusal to provide it will not subject you to any adverse treatment. It will be kept confidential and will be used
only in accordance with Title VI of the Civil Rights Act of 1964.
13. Sex Male Female
This information will be used in accordance with Title IX of the Education Amendment of 1972.
EDUCATION
14. High School attended Date of graduation
15. List in chronological order all undergraduate colleges and graduate or professional schools attended:
Summer School Bulletin Application | 11 www.college.emory.edu/summer
A.
B.
Undergraduate college from (date) to (date) Degree Granted or Expected
Undergraduate college from (date) to (date) Degree Granted or Expected
Graduate or professional school from (date) to (date) Degree Granted or Expected
Graduate or professional school from (date) to (date) Degree Granted or Expected
CURRENT STUDENT STATUS
1. College student currently enrolled in another college.
(Specify college: )
2. College graduate not currently enrolled in any postsecondary institution
(Applications and documentation must be sent to the Graduate School of Arts and Sciences, Emory
University, 209 Administration Building, Atlanta, GA 30322.)
3. College student admitted to Emory College as a transfer student for the upcoming fall term*
4. College student not currently enrolled in any postsecondary institution
5. High school graduate not currently enrolled in any postsecondary school
6. High school graduate admitted to Emory College for the upcoming fall term*
7. High school graduate admitted to another postsecondary school.
8. Graduate student currently enrolled in another institution.
(Specify institution. Applications and documentation must be sent to the Graduate School of Arts
and Sciences, Emory University, 209 Administration Building, Atlanta, GA 30322.)
* Notify Admission in writing of your plans to attend the summer session.
** High school students applying to the Pre-College Program must complete the pre-college application at
http://precollege.emory.edu/.
Submit visiting student application and $50 application fee to Emory University, Office of the Registrar,
100 B. Jones Center, 200 Dowman Drive NE, Atlanta, Georgia 30322.