Application - Texas Southern University: ::em.tsu.edu

Application FeeYou may pay your application fee by check or money order or, at some institutions, by credit card. For application fees andpayment methods, see the “General Application Information” on pages ii through iv. (Be sure the institution to which you areapplying will accept the kind of credit card you list below.)Name: _____________________________________________________________________________________Last First MiddleSocial Security Number * (see note below): _________________________________________________Your application fee is for the: Fall Semester_____ Spring Semester _____ Summer Session _____ Year ________Please check method of payment:• Check or money order ____ (Be sure to include the student’s name and Social Security number on the check or money order.)• Credit card: Visa _____ MasterCard _____ Discover ____ American Express _____ Other: _______________Credit Card Account Number: _____________________________________ Expiration Date: _____________Name of Cardholder: _________________________________________________Cardholder Signature: ________________________________________________Credit Card Billing Address: _________________________________________________________________________(Number and Street or P. O. Box)___________________________________________________________________________(City) (State) (Zip)• Request for fee waiver is attached: Yes ___ No ___(See Instructions, page vi, “Application Fee.”)For Internal Use OnlyExemption Approved ______Exemption Denied ________By _____________________Date _____________________________________________________________________________* (Although entering your Social Security number is optional, providing it will ensure your documents are matched and processed promptly.)www.applytexas.org Transfer/Transient/Former Students - 9www.applytexas.org