APPLICATION - FAMILY BACKGROUND
Father's name ________________ If deceased, when?--------------- Where employed? Position------------------ If father attended college, where? Number of years ---------------- Mother's full name If deceased, when? ________________ (INCLUDE MAIDEN NAME) Where employed? ------------------------------------ If mother attended college, where? ___________ Number of years ---------------- If parents are separated, give date of separation ---------------------------- MONTH YEAR If parents are separated, with whom do you live? --------------------------- Brothers ___________ Sisters ___________ Brothers Sisters ___________ Members of your family who have attended Biol □ ---------------------------- EDUCATIONAL EXPERIENCE Anticipated (or past) graduation date from high school ___________________________ MONTH YEAR Name of high school ___________________________________ Names and ages of children older than yourself: Names and ages of children younger than yourself: Address of high school ----------------------------------- CITY STATE If you have graduated from high school, list in chronological order your activities since high school graduation. (Schools attended, employment, military service, extended travel, etc.) Schools must be listed even though you do not expect transfer credit. Please include Biol □ extension courses, if applicable. School, Work, Travel Dates Have you earned a degree from any college or university? Yes D No D If yes, complete the following: College: __________________ 0egree: __________________ Major: Date Conferred: ________________ Have you ever been dismissed or placed on academic or disciplinary probation? Yes D No D If yes, explain the circumstances: The Scholastic Aptitude Test (SAT) or ACT is REQUIRED, unless as a transfer you will have sophomore status (requires a minimum of 27 accepted units). Please indicate the testing date on which you plan to take (or have taken ) the · SAT _________________ or ACT _________________ MONTH YEAR MONTH YEAR NOTE: Regardless of transfer status nursing majors and students seeking a teaching credential must take the SAT. Indicate your possible major--------------------------------- What are your vocational goals? ------------------------------- NURSING MAJORS: See catalog for procedures for acceptance into the school of nursing. Are you currently a Registered Nurse? __Alicensed Vocational Nurse? __ or enrolled in a nursing program? __ Separate application must be made to the nursing program for Registered Nurses, licensed Vocational Nurses and all others applying to the department of nursing. Nursing departmental application forms will be mailed upon receipt of this application. TRANSFER STUDENTS If you are transfering from another school, please explain your reasons for wanting to transfer
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