Return this form to: - University of North Texas



|Return this form to: |[pic] |Please indicate the semester and year for which|

| | |the Second Bachelor’s degree is sought (check |

|University of North Texas |Toulouse Graduate School |one semester only) |

|Toulouse Graduate School |Application for Second | |

|Graduate Admission Section |Bachelor’s Degree |___ Fall 20____ |

|1155 Union Circle #305459 | |___ Spring 20____ |

|Denton, TX 76203-5017 | |___ May Mini-mester 20____ |

|(940) 565-2383 ■ Fax (940) 565-2032 | |___ Summer I 20____ |

| | |___ Summer II 20____ |

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|This application is valid only for U.S. citizens and permanent resident aliens. |

|All applications must be submitted with a non-refundable application fee of $75 |

|(check, money order or credit card authorization). |

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|Social Security Number (optional): |Date of birth: |Gender: □ Male |

| | |□ Female |

|Name in full (Last, First, Middle, Maiden): |

|Present mailing address: |

|City: |State: |Zip: |Texas County: |

|Telephone: Home: |Cell: |Work: |Fax: |

|Email address: |Place of birth: |

|State of legal |If Texas, how long have you lived |

|residency: |at your present address? (months/years): |

|If you have lived at your present address for less than 12 months, list your prior address: (Include length of time at this address) |

|Are you a U.S. Citizen? □ YES |If not a U.S. citizen, are you a permanent □ YES |

|□ NO |resident of the United States? □ NO |

|If you are a permanent resident, please attach a copy of the front and back of your resident alien card. For tuition classification purposes, you may be required to |

|present the card in person at a later time for verification. |

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|Country of citizenship: |

|Resident alien number: |

|Date of adjudication: |

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|Ethnic background (optional): For reporting purposes only, we would appreciate your indicating which of the groups listed below best describes your ethnic background. |

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|□ American Indian or Alaskan Native |

|□ Asian or Pacific Islander |

|□ Hispanic |

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|□ African American, Black |

|□ White, non-Hispanic origin |

|□ Other |

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|Employment: List employers and employment dates for the last year. |

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|Employer |

|Location |

|Date From |

|Date To |

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|What is your intended field of study for the second bachelor’s degree? |

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|Do you intend to enroll in one of the UNT-Dallas campus programs? □ YES □ NO |

|Major (required; list only valid |

|undergraduate majors): |

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|Have you ever attended UNT? □ YES □ NO |If yes, list the semester | |

| |last enrolled at UNT: | |

|Have you enrolled at UNT |If yes, print name: |

|under another name? □ YES □ NO | |

|College record: List below all college/universities in which you have been officially registered. List most recent first. Do not abbreviate. Failure to list all |

|colleges will be considered an intentional omission and lead to forced withdrawal. |

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|Institution attended |

|(do not abbreviate) |

|City, State |

|Semester/Years attended (beginning – ending) |

|Degree |

|Date awarded/ expected |

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|An official transcript from each school listed other than UNT must be submitted. Former UNT students who submitted transcripts from other schools need not resubmit |

|those transcripts unless contacted by our office. Your application can be processed only after all necessary credentials have been received. Official transcripts, |

|once submitted, are the property of the university and cannot be returned. |

|Are you presently attending another □ YES |If yes, please list the name of the institution |

|college/university? □ NO |(include semester and year enrolled): |

|Are you currently on probation or □ YES |If yes, please list the |

|suspension at another institution? □ NO |name of the institution: |

| Certification: |

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|I certify that all information given on this application is complete and correct and may be used to determine my admission status and my residency eligibility. I |

|authorize the university to verify the information I have provided. I agree to notify the proper officials of the institution of any changes in the information |

|provided. I understand that falsification or omission of any of the academic or residency information will void my admission, cancel my enrollment, and/or result in |

|appropriate disciplinary action. I authorize the University of North Texas to charge my credit card for the appropriate non-refundable application fee. |

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|Applicant’s signature: |

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|Date: |

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|The application for admission to the second bachelor’s program at the UNT Graduate School should be submitted, with official transcripts, at least two months |

|prior to the semester of enrollment. All students are encouraged to apply as early as possible. If application materials are received after the deadline, |

|applications may experience delays in processing and may be subject to late registration and a late registration fee. Only written notice from the dean of the |

|UNT Graduate School constitutes approval of admission, not correspondence with department chairs or with individual faculty members. |

|Immunization is an integral part of your health care. You should make sure that your immunizations for measles, tetanus and poliomyelitis are current. Please |

|contact your physician for more information. |

|It is the policy of the University of North Texas not to discriminate on the basis of race, color, religion, sex, age, national origin, disability (where |

|reasonable accommodations can be made), disabled veteran status or veteran of Vietnam era status in its educational programs, activities, admissions or employment|

|policies. In addition to complying with federal and state equal opportunity laws and regulations, the university through its diversity policy declares harassment|

|based on individual differences (including sexual orientation) inconsistent with its mission and educational goals. Direct questions or concerns to the equal |

|opportunity office, 9940) 565-2456, or the dean of students, 9940) 565-2648. TDD access is available through Relay Texas: (800) 735-2989. |

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|Credit Card Authorization |

|All applications must be submitted with a non-refundable application fee of $75 (check, money order or credit card authorization). Make checks and money orders |

|payable to UNT. |

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|I authorize the University of North Texas to charge my credit card for the appropriate non-refundable application fee. |

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|Credit Card Type: □ MASTERCARD □ VISA □ DISCOVER □ AMERICAN EXPRESS |

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|Card Number: |

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|Expiration Date: (month/year) |

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|Security Code: |

|Date: |

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|Signature of Card Holder: |

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|Printed Name of Card Holder: |

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|Name of student if different than card holder: |

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For office use only

Blocks____________________

Last Semester______________

Citizenship_________________

For office use only

c k m r x i

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