application for transfer admission:
online degree program
2014-15
Where you see the “Question” icon or “Read Me” prompt, find the Application Instructions for that question on pages 4-6. You are accountable for providing complete and accurate information. Omissions or inaccurate information may result in the denial of admission.
PI-1. Sex/Gender. Male Female
PI-2. Social Security Number PI-3. Date of Birth (mm) (dd) (yyyy)
PI-4. Legal Name: To avoid confusion, use your full legal name whenever you contact Admissions.
Personal Information
(PI)C-1. Classification: Transfer: Online Degree Program
NOTE: If you are seeking admission to the Evening Degree Program, STOP. Apply directly at evedegree.washington.edu/edp. If you are seeking admission to an on-campus day
program, STOP. Go to admit.uw.edu/Admission/Transfer. If you are seeking non-degree enrollment for summer quarter, STOP. Apply directly at summer.washington.edu/summer.
Classification
(C)Q-1. Quarter.
AUTUMN 2014
Quarter
(Q)Previous Attendance
(PA)PA-1. Have you ever applied for admission to the UW? No Yes: Quarter/Year
PA-2a. Have you ever attended the UW? No Yes
PA-2b. If yes, indicate the campus / type(s) of enrollment (check all that apply):
Bothell Day Distance/Online Learning ELP (ESL) Evening Extension Summer Tacoma UW College in the High School
PA-2c. Date of First Attendance (mm) (yyyy) PA-2d. UW Student Number (7 digits) ______________________________
MJ-1. Intended Major: Major Code:
Major
(MJ)Program Information:
• For information about the Undergraduate Online Degree Completion program, go to www.onlinedegreecompletion.uw.edu. Application Information:
• Submit a complete application to the Office of Admissions. See the checklist (CL-1) on the last page of this application for a list of required materials. For further information about the application process and minimum admission requirements to the Online Degree program, go to onlinedegreecompletion.uw.edu/admissions.
• If your intended major is Early Childhood and Family Studies, you must submit an additional essay directly to the program. Go to onlinedegreecompletion.uw.edu/early-childhood-degree.
CR-1. Birthplace City and State Country if other than U.S.
CR-2. Are you a U.S. citizen? Yes: skip the next three questions. No: go on to the next question.
CR-3. What is your country of citizenship? Specify country
CR-4. What is your country of permanent residence? Specify country
CR-5. Current or Expected Visa Type or Immigration Status
U.S. Permanent Resident/Immigrant Visa: Registration Number: A#
Date issued/to be issued (mm) (yyyy)
Refugee Political Asylee
International Student: visa types F, J or B, H, L, M, R, TD, TN
The online degree program is not open to international students. For information about on-campus degree programs,
go to admit.uw.edu/Admission/International or contact the Office of Admissions at admit.uw.edu/Contact.
Other Visa Types (A, E, G, I, K, V) Visa Type and Number e.g., A-2, E-2, E-3, V-3
Date visa became (or will become) effective (mm) (yyyy)
Other: any status not included above ________________________________________________________________________________
CR-6. Are you a resident of Washington State? No Yes: If yes, you must include dates of your most recent continuous residence in Washington State.
From (mm) (yyyy) to Present or to (mm) (yyyy)
STOP!
OFFICE USE ONLY
Address
(AD)Citizenship & Residency
(CR)AD-1. Mailing Address
Number and Street
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.) AD-2. Permanent Address Same as Mailing Address in AD-1 Different: complete the address information below
Number and Street
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.) AD-3a. Home telephone (U.S. phone numbers only)
AD-3b. Cell phone (U.S. phone numbers only)
AD-4. Email
Family Information
(F)Family Information. Residents of Washington State under the age of 25 must provide information about at least one parent or legal guardian, preferably both. This
information is required to determine residency classification. Omission of parent/guardian information will result in classification as a nonresident.
All applicants are urged to respond to as many questions in this section as possible. Family information provides context for better understanding an applicant’s
educational environment and circumstances. The information you provide in this section will not disadvantage you in the admission process in any way.
Parent / Legal Guardian
F-1a. Mr. 1 Ms. 2 Mrs. 3 Dr. 4 Rev. 5 Other: 6 specify
F-1b. Name
Last (Family) Name First (Given) Name Middle Jr., etc.
F-1c. Primary parent/guardian for contact with the UW F-2. Relationship to you? Mother 1 Father 2 Guardian 3 Other: 4 specify
F-3. Is s/he living? Yes No: skip to F-8. F-4. Telephone F-5. Email
F-6. Address Same as Mailing Address provided in AD-1 Same as Permanent Address provided in AD-2 Different:
Number and Street Apt.
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.) F-7. Washington State resident? No Yes: From (mm) (yyyy) to Present or to (mm) (yyyy)
You must include the dates of parent/guardian’s most recent continuous residence in Washington State.
F-8. What is parent/guardian’s highest level of formal education completed? (check one)
Did Not Graduate High School 1 HS Graduate 2 Some College but No Degree 3 2-Year Coll. Degree 4 4-Year Coll. Degree 5 Postgraduate Study 6
F-9. If s/he attended college, list college(s) and degree(s):
COLLEGE U.S. STATE COUNTRY YEAR FROM YEAR TO DEGREE
(yyyy) (yyyy)
F-10. Did s/he attend the University of Washington? Yes No F-11. Occupation
F-12. Do you authorize the release of information in your admission file to the parent/guardian named in F-1b? Yes No
Parent / Legal Guardian
F-13a. Mr. 1 Ms. 2 Mrs. 3 Dr. 4 Rev. 5 Other: 6 specify
F-13b. Name
Last (Family) Name First (Given) Name Middle Jr., etc.
F-13c. Primary parent/guardian for contact with the UW F-14. Relationship to you? Mother 1 Father 2 Guardian 3 Other: 4 specify
F-15. Is s/he living? Yes No: skip to F-20 F-16. Telephone F-17. Email
F-18. Address Same as Mailing Address provided in AD-1 Same as Permanent Address provided in AD-2 Different:
Number and Street Apt.
City State (Province/Territory + Country if not U.S.) Zip+4 (or Postal Code if not U.S.) F-19. Washington State resident? No Yes: From (mm) (yyyy) to Present or to (mm) (yyyy)
You must include the dates of parent/guardian’s most recent continuous residence in Washington State.
F-20. What is parent/guardian’s highest level of formal education completed? (check one)
Did Not Graduate High School 1 HS Graduate 2 Some College but No Degree 3 2-Year Coll. Degree 4 4-Year Coll. Degree 5 Postgraduate Study 6
F-21. If s/he attended college, list college(s) and degree(s):
F-25. Income and Household Size.
Were you a Dependent or Independent Student for the 2012 tax year (or most recent year completed)? (Optional)
Dependent Student
Include income earned by your custodial parents/legal guardians, and include the number of dependents they claimed for tax purposes.
Independent Student
Include your income and, if married, your spouse’s income. Do not include as income any student financial aid you received in the form of grants, loans or scholarships.
F-25a. Dependent Students Only
YEAR PARENTS’ GROSS ANNUAL INCOME PARENT FAMILY SIZE
Most recent year completed _____________ $ ____________________.00 __________
Previous year _____________ $ ____________________.00 __________
F-25b. Independent Students Only
YEAR STUDENTS’ GROSS ANNUAL INCOME STUDENT FAMILY SIZE
Most recent year completed _____________ $ ____________________.00 __________
Previous year _____________ $ ____________________.00 __________
SP-1. Will you be enrolling under the UW Faculty / Staff Tuition Exemption Program or Washington State Employees’ Tuition Exemption Program? Yes No SP-2. Are you a veteran of U.S. Military Service, on active military duty, or a member of the National Guard; OR are you the spouse or child of a U.S. military veteran or
active duty service member? Yes No
If yes, select the option that will best describe your status upon enrolling at the UW:
I am a discharged veteran no longer serving on active duty or in the Reserve or National Guard.
I am on active duty.
I am a member of the National Guard.
I am a Reservist, not including ROTC.
I am the child or spouse of a U.S. military veteran or active duty service member.
SP-3. Have you been in foster care in Washington State for at least one year since your 16th birthday? Yes No
Special Programs
(SP)Write your name exactly as it appears on SAT test reports: Last (Family Name)
First (Given Name) Middle (if any)
Write your name exactly as it appears on ACT test reports: Last (Family Name)
First (Given Name) Middle (if any)
Admission Tests
(AT)Admission Tests. By the application deadline, you are required to have all official test scores sent directly from the testing agency. Official
test scores are received electronically. Scores coming from a source other than the testing agency, such as your high school, are not acceptable and will not be accepted. For the self-reported information requested below, record the scores for each test date.
Go to admit.uw.edu/Admission/Freshmen/TestScores for complete, detailed information about reporting and submitting test scores.
AT-1. Check the box(es) of the tests you've taken or plan to take, then answer the follow-up questions for each test.
SAT Reasoning Test
Have you already taken this test? Yes: Go to DATE TAKEN
No: Go to DATE TO BE TAKEN OR RE-TAKEN
ACT with Writing
Have you already taken this test? Yes: Go to DATE TAKEN
No: Go to DATE TO BE TAKEN OR RETAKEN
SAT Scores
DATE TAKEN (MM/YYYY) Verbal or Critical Reading Math Writing
ACT Scores
DATE TAKEN (MM/YYYY) Composite English Mathematics Reading Science Writing
DATE TO BE TAKEN OR RE-TAKEN (mm) (yyyy)
Advanced Level Credit
(AL)Schools & Colleges Attended
(SC)Schools Attended Outside the U.S.
SC-1. Have you ever attended school outside the U.S.? No: skip the rest of SC-1. Yes: complete the other questions in SC-1. Mark an X next to EACH grade you have attended outside the U.S.
__ 1 __ 2 __ 3 __ 4 __ 5 __ 6 __ 7 __ 8 __ 9 __ 10 __ 11 __ 12 __ 13 __ 14 __ 15 __ 16 List all schools you attended outside the U.S. beginning with Grade 1.
NAME OF SCHOOL LOCATION GRADE LEVEL(S) CALENDAR YEAR LANGUAGE OF
E.G. 2005-06 INSTRUCTION
example:
West Island School
Hong Kong
9-12
2009-13
Mandarin
SC-3.
High School Graduation
Have you graduated — or will you graduate — from high school (not GED)? Yes: mm/yyyy of Graduation No: Highest grade level completed
SC-4.
Homeschool
Have you ever participated in a homeschool program? No Yes: select all that apply: Grade(s) 9 10 11 12
SC-5.
High School / Secondary Schools Attended
List all high schools and secondary schools you have ever attended, are currently attending, or will attend before enrolling at the UW. Do not exclude or omit any, regardless of how many credits you earn(ed) there or the nature of the program in which you were/are enrolled. Failure to disclose all schools may result in denial of admission to the UW.
Last High School Attended
Other HIgh School(s) Attended (in reverse order of attendance)
SC-6.
Colleges/Universities Attended
List all colleges and universities you have ever attended, are currently attending, or will attend before enrolling at the UW. Include colleges attended while also enrolled in high school programs such as Running Start, college in the high school, etc. Do not exclude or omit any institutions, regardless of how many credits you earn(ed) there or the nature of the program in which you were/are enrolled. Failure to disclose all colleges and universities may result in denial of admission to the UW. Attach an additional page if necessary.
Last College Attended
Other College(s) Attended (in reverse order of attendance)
CEEB CODE NAME OF COLLEGE, UNIVERSITY, ETC. LOCATION (CITY, STATE; COUNTRY IF OTHER THAN U.S.) DATES OF ATTENDANCE (MM/YY)FROM TO CEEB CODE NAME OF HIGH SCHOOL OR SECONDARY SCHOOL LOCATION (CITY, STATE; COUNTRY IF OTHER THAN U.S.) DATES OF ATTENDANCE (MM/YY)FROM TO IF GRADE 9-12,SPECIFY GRADE LEVEL(S)
College Courses
(CC)CC-T1. It is very important that you list all college courses you are taking or plan to take between now and when you plan to attend the UW. List only those courses that will not appear on the college transcripts you are having sent to the UW. Attach an additional page if necessary.
COLLEGE TERM TYPE TERM/YEAR PREFIX & NUMBER SHORT TITLE (20 Character limit) CREDITS GRADE INCOURSE
ex:
Bellevue College
QTR SEMAut 2013
Art 101
Art Intro
5
B
QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM QTR SEM
AL-1. Do you expect to earn an International Baccalaureate (IB) diploma? No Yes
AL-2. Have you already earned — or do you expect to earn — any advance-level credit (e.g., A-level, STMP, HKALE, Arbitur, etc.,) before enrolling at the University of
Washington? Do not include AP or IB credit.
No Yes: Please specify Certificate, Diploma, or Advanced Credit and date.
NAME OF SCHOOL CERTIFICATE/DIPLOMA/ADVANCED CREDIT DATE AWARDED OR EXPECTED (mm/yyyy)
ex:
Singapore American School
A-Level
05/2013
Advanced Level Credit
(AL)DG-1. Have you already earned — or do you expect to earn — an associate or bachelor’s degree before entering the University of Washington?
No Yes: specify degree and date expected.
COLLEGE NAME OF DEGREE DATE OF DEGREE EARNED OR EXPECTED
ex:
Yakima Valley CC
Associate of Arts & Sciences
June 2014
CL-1. I understand that a complete application and ALL of the following materials must be submitted to the UW Office of Admissions by the application deadline: f Application form signed and completed in full
f Personal Statement (see page 7 of the instructions) f $60 nonrefundable application fee
f Official high school transcript (yes, this is required!)
f One official transcript from each college or university attended
f Optional: Official test scores from SAT Reasoning Test or ACT with Writing, sent directly from the testing agency. I understand that any additional materials required for the major must be submitted directly to the academic department by the application deadline. The department of Early Childhood and Family Studies (ECFS) requires an additional essay. Go to onlinedegreecompletion.uw.edu/early-childhood-degree for further details.
Checklist
(CL)Signature
(SS)SS-1. In signing this form, I certify that the statements I have made in this application are complete and true to the best of my knowledge. I acknowledge that it is my responsibility to be aware of all pertinent admission and application requirements and conditions that I have read and understand the application instructions. I acknowledge that failure to disclose complete and accurate information, or failure to submit all required application information — including those outlined in the Checklist CL-1 — may result in the denial of admission or subsequent dismissal from the University of Washington. I understand that my complete application must be signed and submitted by the application deadline to be considered for admission.
Signature of Applicant ____________________________________________________________________ Date ___________________
APPLICANT'S NAME DATE OF BIRTH mm dd yyyy
Statistical Information
(ST)The University of Washington is required by the U.S. Department of Education to ask you about your ethnic identity. The information you provide also allows the University of Washington to do the following:
1) We can report aggregate demographic data to state and federal agencies as required by law. 2) We can monitor the effectiveness of our recruitment and outreach efforts.
3) The information may assist in the awarding of privately funded diversity scholarships.
This information will be separated from your application file and will not be used in the admission review process.
ST-1. Are you of Hispanic or Latino origin? (Check all that apply.)
No 999
Yes, In addition, select from the following:
Mexican or Mexican American or Chicano 722 Peruvian 726 Other Hispanic or Latino: 739
Argentinian 700 Puerto Rican 727
Chilean 706 Salvadoran 712
Colombian 707 Spanish/Spaniard 730
Cuban 709 Hispanic 717
ST-2. Additionally, what race(s) do you consider yourself? Regardless of your answer to the previous question, please mark the following box(es) to indicate what you consider yourself to be.
African American or Black 870
Alaska Native or American Indian 599
If possible, please specify tribal or corporate affiliation (e.g., Shoshone)
Verification of tribal or corporate affiliation is recommended.
UW departments and programs are encouraged to consider tribal or corporate enrollment or affiliation as a positive factor in admission, financial aid, and outreach programs. Verification of affiliation — which is required in order to benefit — consists of one of the following: Verification of tribal affiliation, which is required in order to benefit, consists of one of the following:
f Official tribal identification. Examples: copy of a Tribal Enrollment card, treaty fishing card, corporation papers,
or Bureau of Indian Affair (BIA) document.
f Certificate of membership verification by the BIA, a tribal enrollment official, community official or proof of direct descendancy.
Asian American. In addition, select from the following:
Asian Indian 600 Bangladeshi 601 Cambodian 604 Chinese 605 Filipino 608 Hmong 609 Indonesian 610 Japanese 611 Korean 612 Caucasian or White 800
Pacific Islander. In addition, select from the following:
Laotian 613 Other Asian American: 986
Malaysian 614 Pakistani 616 Singaporean 637 Sri Lankan 617 Taiwanese 606 Thai 618 Vietnamese 619 Asian American 621
Native Hawaiian 653 Other Pacific Islander: 985
Samoan 655
Fijian 676
Guamanian or Chamorro 660
(Specify, e.g., Ecuadoran, etc.)
(Specify, e.g., Mongolian, etc.)
