Shenandoah Undergraduate Application For Admission Page 7
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8Section VI – Other Information
Family Information
_______________________________________________
_______________________________________________
Circle: Father/Guardian/Spouse name
Circle: Mother/Guardian/Spouse name
_______________________________________________
_______________________________________________
Home address (if different from yours), city, state, zip
Home address (if different from yours), city, state, zip
_______________________________________________
_______________________________________________
College or University attended
Highest Degree Earned
College or University attended
Highest Degree Earned
_______________________________________________
_______________________________________________
College or University attended
Highest Degree Earned
College or University attended
Highest Degree Earned
_______________________________________________
_______________________________________________
Occupation
Occupation
______________________ / ________________________
______________________ / ________________________
Home Telephone
Cell Phone
Home Telephone
Cell Phone
_______________________________________________
_______________________________________________
E-mail
E-mail
With whom do you reside?______________________________________________________________________________
Do you have a parent/guardian who works at Shenandoah University?
Full Name:__________________________________
Other
Are you currently active duty military?
K Yes
K No List previous military experience and years____________________
___________________________________________________________________________________________________
Have you ever been convicted of a felony?
K No
K Yes
If “yes,” provide a written explanation.
How did you first hear about Shenandoah University? (check one only)
K Direct mail K College fair K Alumni — Name of Alumni:_________________________________________________
K Current student K Friend K Parent K High school/college counselor K Activities on Shenandoah campus
K Visit to your school by a Shenandoah Admissions Counselor K Visit to your school by a Shenandoah Coach
K Newspaper, Magazine, Radio, or Television Advertisement K Summer camp K Website
K Other - Please explain________________________________________________________________________________
The following information is optional.
List any friends who may be interested in learning about Shenandoah University:
________________________________________________________________________________________________
Name
Street Address
City
State
Zip
________________________________________________________________________________________________
Name
Street Address
City
State
Zip
Signature Section
I certify that the statements made in this application are correct. I understand that failure to provide accurate information will
result in the cancellation or rejection of my application or, if admitted and enrolled, dismissal from Shenandoah University. I agree to notify
the Office of Admissions in writing of any changes to any part of this application. If admitted, I agree to comply with all policies and regula-
tions of Shenandoah University in effect while I am a student and to assume responsibility for any financial obligations that I may incur. I
understand that all information furnished to the Office of Admissions in connection with this application will be treated confidentially, and
will only be disclosed to Shenandoah University officials having a legitimate educational interest. Should I be admitted and enrolled at
Shenandoah University, reports and recommendations on my behalf will not become a part of my permanent student record.
Student’s Signature __________________________________________ Date ____________________________________
Parent’s/Guardian's Signature __________________________________ Date ____________________________________
Shenandoah University
Undergraduate Application 2013
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