READMIT APPLICATION Please complete this application clearly in black or blue ink. Submit it to the Admissions Office with a $10 application fee (non-refundable). This application is only for returning degree-seeking students. Check the session you are applying for: □ Summer 20____ □ Fall 20____
□ Spring 20________
Anticipated Major CONTACT INFORMATION LAST NAME
FIRST
MIDDLE SUFFIX (JR. ETC.)
MAIDEN / Any other name on record
DATE OF BIRTH (MONTH/DAY/YEAR)
SOCIAL SECURITY NUMBER
E-MAIL ADDRESS
MAILING ADDRESS
CITY
STATE
PHONE NUMBER
CELL PHONE NUMBER
ZIP
AGE
COUNTY
PARENT/GUARDIAN INFORMATION Name your parent/guardian, spouse, or closest relative: LAST NAME
FIRST
Relationship
ADDRESS OF PERSON LISTED ABOVE CITY
STATE
ZIP
PHONE
Have you attempted any additional college credit since you last attended USC? □ Yes □ No If Yes, Where? ________________________________________________________________________
RESIDENCY Are you a legal resident of South Carolina? □ Yes □ No Are you: □ Military Dependent □ Active Military Are you a United States Citizen? □ Yes □ No □ Foreign Permanent Resident Alien # ________________________________________ List the city and state where you have lived for the past three years. From
To
ETHNIC BACKGROUND The University of South Carolina Beaufort is required to collect information on the ethnic and racial composition of its student body and report this information to the U.S. Department of Education.
Do you consider yourself to be either Hispanic, Latino or of Spanish origin? __Yes __No Please select one or more of the following groups with which you identify: □ American Indian or Alaskan Native □ Black or African American □ White □ Asian □Native Hawaiian or Other Pacific Islander
CERTIFICATION AND SIGNATURE I certify that all information provided in this application is complete and correct and I understand that any false information or omission of previous college attendance is cause for immediate cancellation of registration at the University of South Carolina Beaufort.
Signature _________________________________________ Date _____________________________