Last NameFirstMI

E-mail Address (Required) Date of birth

AddressCity

CountyStateZip CodePhone

Last nameFirst

Relationship: ParentGuardianSpouseOther(If other)

AddressCity

CountyStateZip CodePhone

Sex: Male Female

Ethnic Background:
African-American/Black Asian/Pacific IslanderHispanic/Spanish
Native AmericanCaucasian/WhiteOther

Citizenship Status:
U.S. Citizen Immigrant, Permanent Resident F or J Visa

If you claim Indiana residence, ISU reserves the right to request documentary evidence in support of the claim before classification as an Indiana resident.
Legal state of residencesince

Intended Major:
ArtArt EducationArt History (A.B.)

Educational Objective:
Associate degree (2 years)Baccalaureate degree (4 years)
Second degreeTeaching Certificate

Do you plan to teach? YesNo

Have you ever enrolled at ISU before? YesNo
if yes, list last term of enrollment

High School Namemm/yy graduation

CityCountyState

Do you have any college credits?
YesNo

Are you a 21st Century Scholar? YesNo

Please list all colleges, universities, or post-high school institutions you have attended or are currently attending. Failure to list all institutions attended, or failure to provide official transcripts from each is cause for immediate cancellation of your admission to the University.

List Institutions, dates attended, and credit hours or degrees earned in the box below.

Have you ever been dismissed, suspended, or expelled from any institution?

YesNo If Yes, please explain in the box provided below.

Has any member of your family attended ISU? YesNo

Graduated from ISU? YesNo If yes, when:

NameRelationship

Father's Employer and Job Title

College attended/year graduated

Mother's Employer and Job Title

College attended/year graduated

Spouse's Employer and Job Title

College attended/year graduated

Pleas List all High School Extracurricular Activities in the box below.

In the box below, or in a letter mailed to the address at the bottom of this form, please describe any special circumstances which you believe the admission committee should consider.