USVI Public Records

Document text

LIU APPLICATION FOR UNDERGRADUATE READMISSION 2 John Brewer’s Bay •St. Thomas • U.S.V.I. 00802 - 9990 • Tel: (340) 693-1160 • Fax: (340) 693-1167 RR#1 – Box 10,000 Kingshill St. Croix, VI 00850-9781 Tel: (340) 692-4158 • Fax: (340) 692-4115 Email: registrar@uvi.edu • www.uvi.edu This Application is for students who previously attended the University of the Virgin Islands and are reapplying for admission to complete a degree. Semester you intend to enroll: □Spring (January) 20 □ Fall (August) 20 Enrollment Campus: □ St. Croix □ St. Thomas Student UVI ID# - -_ Social Security No. _ -____- Date of Birth: _____ / ____ / ____ Gender: Female □ Male □ Other □ Status: Citizenship: ☐ U.S.A. Naturalized U.S. # Permanent Resident# ☐ Other Ethnicity: Are you of Hispanic or Latin Origin: Yes □ No □ Race: Please choose one or more from the following: ☐ African American/Black ☐ American Indian/Alaskan ☐ Native Hawaiian/ Pacific Islander ☐ Asian ☐ White ☐ Other Name Other name your UVI record may be listed under ___________________________________________________ Address ______ Street Apt# City State ZIP CODE □Check here if your address has changed since you last attended the University of the Virgin. Home Telephone Cell Phone Email address ___________________________________________________________________________________________________ First term attended Last term attended _ Intended Major Minor: _ Previous Major_ Associates (2 Year): □AA □AS □AAS Bachelors (4 Year): □BA □BBA □BS (see UVI program majors and codes on page 2) List all schools you attended after leaving UVI (please have official transcripts forwarded to the Office of the Registrar) List all schools in chronological order Dates of Attendance From To Month / Year Month / Year 1 2 3 1. Have you ever been suspended or dismissed for academic reasons from another academic institution? Yes □ No □ 2. Have you ever been placed on disciplinary probation, been suspended or dismissed for disciplinary reasons from another academic institution? Yes □ No □ 3. Have you ever been convicted of a crime, other than a traffic violation? □ Yes* □ No If yes: □ Felony or □ Misdemeanor * an official police report is required to be submitted I certify that all information provided is accurate and complete I further understand that the University of the Virgin Islands reserves the right to amend or rescind any acceptance, if it is discovered that I have withheld or falsified any information. Signature Date_ UVI does not discriminate on the basis of sex, handicap, race, national origin, religion or political belief in any of its educational programs and activities, including employment practices and its policies relating to recruitment and admission of students. DO NOT WRITE BELOW THIS LINE Transfer Institution Credits/GPA UVI Credits Earned/GPA STUDENT INFORMATION INSTITUTION INFORMATION