University of Connecticut s2

UNIVERSITY OF CONNECTICUT BACHELOR OF GENERAL STUDIES (BGS) ADMISSION APPLICATION

PREFERRED CAMPUS (select one) Avery Point Greater Hartford Stamford Storrs Torrington Waterbury

Application Procedure: Please complete each section of this application and submit it to your campus office by mail, fax, email, or in person. For campus contact information, please visit: BGS.UConn.edu, or call 1-888-BGS-5556. A $95 application fee, if applicable, must be sent to your preferred campus upon application submission*. Checks should be made payable to the “University of Connecticut.” Request that your official high school transcript and transcripts from each university you have attended be sent directly to your campus office.

International Students: Please contact your campus office before completing this application.

*Note: Fee is waived for Connecticut Community College graduates and students in schools and colleges within UConn; other exclusions may apply. Contact your campus for details at 1-888-BGS-5556.

SECTION ONE: PERSONAL DATA

First Name: Middle Initial: Last Name: Street Address: Street Address II: City, State, Zip:

Permanent/Foreign Address, if different:

Day Phone: Evening Phone: Cellular Phone:

Email Home: Email Work: Facsimile:

Country of Birth: Country of Citizenship: Date of Birth:

Social Security Number*: Visa Status (if applicable):

*Your Social Security Number is optional on this form; however, it is required upon admission to the University.

GENDER MARITAL STATUS Male Single Divorced Female Married Separated Widowed Number of Dependents:

VETERAN STATUS Are you a Veteran? Dates of Service Yes Active Service: No Separation:

Ethnicity and Race: Colleges and universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities to describe the racial/ethnic backgrounds of our students. In order to respond to these requests, we ask you to answer the following question. This complies with the U.S. Department of Education’s standard for ethnic and racial data collection.

ETHNICITY (please select one or more) Puerto Rican South American Black or African American Mexican American American Indian or Alaska Native White Central American Asian Other Native Hawaiian or Pacific Islander Page 1 of 3 Financial Aid: Applicants are encouraged to apply for financial aid at the same time as applying for admission. To be considered for financial aid, you must complete the Free Application for Financial Aid (FAFSA). For more information about financial aid, visit: FAFSA..ed.gov.

SECTION TWO: EDUCATIONAL BACKGROUND

High School: City & State: Graduation Year:

Please list all colleges and universities attended: Institution City & State # of Credits Earned Degree Year

Are you currently enrolled in any college or university? Yes If “yes,” institution name: No

Do you have any courses in progress? If “yes, “ please reference courses below. Yes No

SECTION THREE: EMPLOYMENT BACKGROUND

Are you currently employed? If “yes,” select general work schedule: If “yes,” select general work status: Yes Days Full Time No Evenings Part Time

Please list your most recent employer. Company City & State Title Dates Employed

SECTION FOUR: PERSONAL ESSAY/STATEMENT OF OBJECTIVES

The personal essay is an opportunity for you, as a prospective student, to demonstrate your ability to write at the college level. In your essay, please discuss your educational career, personal goals, and objectives. Please also describe how you believe this degree program will help you to achieve your goals. All elements of a college-level essay should be included in your personal essay, including appropriate punctuation, grammar, and spelling. Please type your essay below, include it as an attachment, or print a hardcopy to accompany your application. The personal essay should be 1 – 2 pages in length.

SECTION FIVE: CANDIDATE’S STATEMENT

To the best of my knowledge, the information in this application is complete and accurate. I realize that failure to disclose fully and accurately all facts related to my application may result in dismissal from the University of Connecticut. If admitted, I will comply with all of the rules and regulations of the University of Connecticut. I hereby grant the University of Connecticut authorization to examine my academic records.

Applicant’s Signature Date

of 3 For those submitting this form electronically, I agree to the above statement: Date: