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Student Number (6-Digits):
Personal ID Number
(PIN)
:
Term to Enroll:
Fall
Summer
Spring
Enrollment Status:
Transfer
Transient
Freshman
Sophomore
Full Name:
Email Address:
Other last Names:
Birth Date (mm/dd/yyyy):
Mailing Address:
Zip Code:
Home Phone Number:
Work Phone Number:
Last date of attendance at SUSCC:
Academic Standing at SUSCC:
Clear
Probation
Warning
Suspension
Major and Degree:
Transfer College:
Have you attended any other college or university since your last term of enrollment at Southern Union?
Yes
No
If you answered "Yes" to the previous question then please list the schools here. Include the name of the school, the city/state, your academic standing, and the date of attendance.
Note:It is the student's responsibility to furnish the college with all official high school, GED, transient form, or college transcripts. An applicant on academic suspension from another college is ineligible to attend Southern Union. Please see the college catalog for complete informaiton.
By submitting this application you agree to the following:
I certify that I am the individual described in this declaration and that the statements above are true and correct to the best of my knowledge. I will abide by the rules and regulations of this college. If any part of this record has been falsified, I understand that I am subject to immediate dismissal from the college.
I certify that I comply with the provisions of the United States Military Selective Service Act (60 U.S.C. APP453) by having registered with the Selective Service Board or that I am not yet 18 years of age and I will register when required or that I am not required by law to register.
