High School Name (No abbreviations, please)
State
City
From (MM/YY) To (MM/YY)
Diploma, Degree or
Hours Completed:
Last College Name (No abbreviations, please)
State
City
From (MM/YY) To (MM/YY)
Prior College Name (No abbreviations, please)
State
City
From (MM/YY) To (MM/YY)
Will you have at least 30 semester hours (45 quarter hours) of transferable college credit prior to enrolling at GC?
Yes No
IV. Residency Information
Are you applying for in-state tuition?
If you answered “yes” to the above question, all of the following must be answered:
Have you established and maintained permanent home in Georgia (according to the definition on page 3) for at least 12 consecutive months immediately preceding
the first day of classes for the term in which you plan to enroll?
What is your Georgia county of residence? ___________________________________________
Have you ever lived in another country or in any U.S. state/territory other than the state of Georgia?
I have continuously resided in the state of Georgia since ____________ .
If you have lived outside the state of Georgia, what was your primary reason for moving to the state of Georgia? __________________________________________________________________________________________________________
Have you attended a Georgia high school for at least one year?
Have you graduated, or will you graduate from a Georgia high school?
In what U.S. state/territory were the following issued:
Drivers License ____________________________________________
Motor Vehicle Registration _____________________________
Voter Registration _________________________________________
In what U.S. state/territory did you file state income taxes in the past year? __________________________
If you are under the age of 24, has a parent(s) or U.S. court-appointed legal guardian established and maintained domicile (according to the definition on page 3) in Georgia for at
least 12 consecutive months immediately preceding the first day of classes for the term in which you plan to enroll?
I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits
the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false
statement may subject me to immediate dismissal from the institution. Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
In accordance with Board of Regents Policy 4.3.4, all applicants who are accepted for admission or readmission to Georgia College for Fall, 2011 or any academic semester thereafter, and who seek to be classified as in-state for tuition purposes, will be
required to provide validation of residency and lawful presence in both the State of Georgia and the United States. Acceptance to Georgia College is
conditional until lawful presence is verified.
Signature of Applicant (required of all applicants) Date
Dates Attended
Please submit additional prior colleges attended on a separate page.
Yes No
Yes No
Diploma, Degree or
Hours Completed:
Diploma, Degree or
Hours Completed:
For more information, call the
Georgia College Office of Admissions
at 1-800-342-0471 or locally at 478-445-2774
or visit our website at http://www.gcsu.edu/admissions
If Freshman, did you take the...
Yes No
III. Citizenship Status
U.S. Citizen
Alien, resident (please
submit documentation)
Visa Type
Country of Citizenship (if not U.S.)
Yes No
Yes No
GED:
ACT:
SAT:
Date taken:
Date taken:
Date taken:
When did you request your scores be sent to GC?
English Score
Math Score
Evidence
Based Reading
& Writing
Math Score
Reading Score
Composite Score
/ / /
/ / /
/ / /
Yes No
Yes No
Yes No
Yes No
V. Military Information (Answer all)
Are you currently active duty, a veteran, a member of the National
Guard, or a reservist in the U.S. Armed Forces?
Please Specify:
___ Active Duty ___ Veteran ___ National Guard ___ Reservist
Branch:
___ Air Force ___ Army ___ Coast Guard ___ Marine ___ Navy
If National Guard or Reservist, are you stationed or assigned to
Georgia?
Are you the spouse or dependant child under the age of 24 of
someone who is currently active duty, a veteran, member of the
National Guard, or a reservist in the US Armed Forces?
Please specify current status/component of the military member:
___ Active Duty ___ Veteran ___ National Guard ___ Reservist
Military members branch of service:
___ Air Force ___ Army ___ Coast Guard ___ Marine ___ Navy
Is the military member stationed or assigned to Georgia?
If National Guard or Reservist, is the military member stationed
or assigned to Georgia?
Yes No
Yes No
Yes No
Yes No
Yes No
What is the highest level of education obtained by your parent(s)/guardian(s)?
Parent/Guardian 1: _______ Parent/Guardian 2: _______
(A) Less than high school (B) High school diploma or equivalent (e.g., GED)
(C) Some college but no formal award (D) Certificate, less than an Associate's degree
(E) Associate's degree (A.A., A.S., etc.) (F) Baccalaureate degree (B.A., B.S., etc.)
(G) Master's degree (M.A., M.S., etc.) (H) Doctoral/Professional degree (Ph.D., M.D., J.D., etc.)
(I) Unknown