please complete and mail to you may also apply …undergraduate admission duesenberg welcome center...
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Valparaiso University | 1
PRINTABLE APPLICATION
PLEASE COMPLETE AND MAIL TOVALPARAISO UNIVERSITY
Undergraduate Admission • Duesenberg Welcome Center1620 Chapel Drive • Valparaiso, IN 46383
YOU MAY ALSO APPLY ONLINE AT
valpo.edu/apply
Name: _________________________________________________________________________________________________________________________ FIRST/GIVEN NAME MIDDLE NAME (COMPLETE) LAST/FAMILY NAME
Preferred Name: ______________________________________ Former Last Name (if any): ________________________________________________
Birth Date (MM/DD/YYYY): _____________________________ Gender: q Male q Female
Address: _______________________________________________________________________________________________________________________ NUMBER AND STREET APARTMENT NUMBER
___________________________________________________________________________________________________________________CITY OR TOWN STATE/PROVINCE ZIP/POSTAL CODE COUNTRY
Home Phone: ________________________________________ Cell Phone: _____________________________________________________________
q I give permission to Valparaiso University to send me important updates via text messaging
Email Address: _____________________________________________________ Social Security Number: _____________________________________(For official University correspondence) (Required if you plan on filing the FAFSA – Free Application for Federal Student Aid.
United States citizens/permanent residents only)
Religious Denomination: ____________________________________________
PERSONAL INFORMATIONPlease enter your name exactly as it appears on your passport and/or other official documents.
UNDERGRADUATE ADMISSION | Duesenberg Welcome Center, 1620 Chapel Drive, Valparaiso, IN 46383 | valpo.edu
2 | Valparaiso University Valparaiso University | 3
PERSONAL INFORMATION (CONTINUED)ETHNICITYAre you Hispanic or Latino? q Yes q No
Please check all that apply:
q American Indian or Alaska Native q Asian q Black or African American
q Native Hawaiian or Other Pacific Islander q White or Caucasian q Other: ____________________________________
CITIZENSHIP Select one and provide details.
q U.S. Citizen q U.S. Permanent Resident q Not a U.S. Citizen or Permanent Resident
_______________________________ ______________________________________ _____________________________________________PLACE OF BIRTH COUNTRY OF CITIZENSHIP COUNTRY OF CITIZENSHIP
______________________________________ _____________________________________________ U.S. ALIEN REGISTRATION NUMBER VISA STATUS
______________________________________ _____________________________________________ COUNTRY OF BIRTH COUNTRY OF BIRTH
YOUR FAMILY INFORMATIONPARENT/LEGAL GUARDIAN 1 Please only enter information for parents who are still living.
Name: _________________________________________________________________________Relationship: _________________________ TITLE (DR., MR., MRS., ETC.), FIRST, LAST/FAMILY NAME
Address: _______________________________________________ Home Phone: _______________________________________________
Cell Phone: ____________________________________________ Email Address: ______________________________________________
q I give permission to Valparaiso University to send me important updates via text messaging
Employer: _____________________________________________ Occupation: ________________________________________________
College Attended: ______________________________________ Degree Earned: _____________________________________________
PARENT/LEGAL GUARDIAN 2
Name: _________________________________________________________________________Relationship: ________________________ TITLE (DR., MR., MRS., ETC.), FIRST, LAST/FAMILY NAME
Address: _______________________________________________ Home Phone: _______________________________________________
Cell Phone: ____________________________________________ Email Address: ______________________________________________
q I give permission to Valparaiso University to send me important updates via text messaging
Employer: _____________________________________________ Occupation: ________________________________________________
College Attended: ______________________________________ Degree Earned: _____________________________________________
Do you have a parent who is a full-time rostered, professional Lutheran church worker? q Yes q No
Do you have any relatives who have attended or are attending Valparaiso University? q Yes q No
If yes, please provide their name and relationship to you: _________________________________________________________________ NAME/RELATIONSHIP
_________________________________________________________________ NAME/RELATIONSHIP
SIBLINGS Please provide the following information:
______________________________________ ______________________________ _____________________________________________RELATIONSHIP AND CURRENT AGE RELATIONSHIP AND CURRENT AGE RELATIONSHIP AND CURRENT AGE______________________________________ ______________________________ _____________________________________________FIRST AND LAST NAME FIRST AND LAST NAME FIRST AND LAST NAME______________________________________ ______________________________ _____________________________________________SCHOOL SCHOOL SCHOOL
YOUR EDUCATIONHIGH SCHOOL INFORMATION Please enter information for the high school from which you will graduate.
Name: ________________________________________ Date of Graduation: __________________________________________________
Address: ____________________________________________________________________________________________________________ NUMBER AND STREET APARTMENT NUMBER
_____________________________________________________________________________________________________________________CITY OR TOWN STATE/PROVINCE ZIP/ POSTAL CODE COUNTRY
q Check here if you are currently homeschooled. Date GED Received (General Equivalency Diploma): _____________________
GUIDANCE COUNSELOR INFORMATION
Name: _______________________________________ Email Address: ______________________________________________________
COLLEGES/UNIVERSITIES ATTENDED If you are working toward or have obtained any prior college credits, please provide the requested information below.
______________________________________________ __________________________________ _________________________________COLLEGE NAME CITY OR TOWN STATE/PROVINCE
______________________________________________ __________________________________ _________________________________DATES ATTENDED (MONTH/YEAR TO MONTH/YEAR) UNITS/CREDITS COMPLETED UNITS/CREDITS IN PROGRESS
TESTS
Have you taken the SAT? q Yes Please indicate dates taken (Month/Year) _______________
q No When do you expect to do so? (Month/Year) _______________
Have you taken the ACT? q Yes Please indicate dates taken (Month/Year) _______________
q No When do you expect to do so? (Month/Year) _______________
Have you taken the TOEFL or IELTS? q Yes Please indicate dates taken (Month/Year) _______________
(international students only) q No When do you expect to do so? (Month/Year) _______________
ACADEMIC HONORS
Briefly list or describe any scholastic distinctions or honors you have achieved since the ninth grade (e.g., National Merit, Cum Laude Society, etc.)_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
________________________________________________________________________________________________
ENROLLMENT
When do you plan to enroll? q Spring 2018 q Summer 2018 q Fall 2019 q Spring 2019
What is your area of academic interest? _________________________________________________________________________________
What is your intended career path? _____________________________________________________________________________________
Do you plan to apply for financial aid by completing the Free Application for Federal Student Aid (FAFSA)? q Yes q No(United States citizens and United States permanent residents only)
How did you hear about Valpo? ________________________________________________________________________________________
_____________________________________________________________________________________________________________________
UNDERGRADUATE ADMISSION | Duesenberg Welcome Center, 1620 Chapel Drive, Valparaiso, IN 46383 | valpo.edu UNDERGRADUATE ADMISSION | Duesenberg Welcome Center, 1620 Chapel Drive, Valparaiso, IN 46383 | valpo.edu
4 | Valparaiso University Valparaiso University | 5
PRINTABLE APPLICATION
OFFICIAL TRANSCRIPT REQUEST
TO THE APPLICANT:
Please complete this section and give this form to your high school counselor right away. (Note: Your official high school transcript and test scores must be received before we can provide an admission decision.)
Full Legal Name: _____________________________________________________________________________________________________ FIRST/GIVEN NAME MIDDLE NAME (COMPLETE) LAST/FAMILY NAME
Mailing Address: _____________________________________________________________________________________________________ NUMBER STREET APT. #
_____________________________________________________________________________________________________________________CITY STATE/PROVINCE ZIP/POSTAL CODE COUNTRY
TO THE COUNSELOR:
Please submit this student’s official transcript, along with this form, to Valparaiso University as soon as possible.
Valparaiso University Undergraduate Admission Duesenberg Welcome Center 1620 Chapel Drive Valparaiso, IN 46383
If you have any questions, please call us at 219.464.5011, or email us at [email protected].
Full Legal Name: _____________________________________________________________________________________________________ FIRST MIDDLE LAST/FAMILY
Title/Position: __________________________________ School/Organization: _________________________________________________
Phone Number: _________________________________ Email Address: ______________________________________________________
Signature: ______________________________________Date: _______________________________________________________________
Your student has already submitted their portion of our application. All we need in order to provide an admission decision is the student’s test scores, along with this form and their official transcript. Thank you in advance for your help!
EXTRACURRICULAR ACTIVITIESPlease list the activities you participated in during high school and indicate the corresponding school year(s).
____________________________________________________________________________________ q 9th q 10th q 11th q 12th
____________________________________________________________________________________ q 9th q 10th q 11th q 12th
____________________________________________________________________________________ q 9th q 10th q 11th q 12th
____________________________________________________________________________________ q 9th q 10th q 11th q 12th
____________________________________________________________________________________ q 9th q 10th q 11th q 12th
Please list any activities below that you plan to participate in at Valparaiso University.
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
WRITING SAMPLEGOOD NEWS! You don’t need to submit a new essay. Instead, please type a personal statement of at least 250 words.
Please choose one of the topics listed below and attach it to your application.
1. Describe the ways you anticipate your Valpo experience will affect your life’s personal journey.
2. Evaluate a significant experience or achievement that has special meaning to you.
3. Indicate a person who has had a significant influence on you and describe that influence.
4. Discuss your reasons for wishing to pursue a college degree.
Have you ever been suspended from any school? q Yes q No
(If yes, please provide the approximate dates and explain the circumstances)
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Have you ever been convicted of a felony? q Yes q No
(If yes, please provide the approximate dates and explain the circumstances)
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
IN ADDITION TO YOUR APPLICATION, PLEASE MAKE SURE YOUR TEST SCORES AND HIGH SCHOOL TRANSCRIPT ARE SENT TO VALPARAISO UNIVERSITY.
q I, the undersigned, agree that any information furnished to Valparaiso University, at any time and regardless of whether or not I am accepted as a student at Valparaiso University, including all information and materials of any kind received by Valparaiso University from any sources, or prepared by anyone at its request, shall not be disclosed to anyone, including the undersigned, except that an authorized official at the University may at his/her discretion, for official purposes, disclose any or part thereof to such person as necessary. I certify that all information on my application is complete, factually correct, and honestly presented.
________________________________________________________________________________________________________________________SIGNATURE DATE
UNDERGRADUATE ADMISSION | Duesenberg Welcome Center, 1620 Chapel Drive, Valparaiso, IN 46383 | valpo.edu UNDERGRADUATE ADMISSION | Duesenberg Welcome Center, 1620 Chapel Drive, Valparaiso, IN 46383 | valpo.edu