WINSTON-SALEM STATE UNIVERSITYMAIL COMPLETED APPLICATION TO: 601 S. Martin Luther King, Jr. Drive, Anderson Center, Suite 137, Winston-Salem, NC 27110

FRESHMEN

TRANSFER STUDENTS

SECOND DEGREE STUDENTS

NON-DEGREE & SUMMER SCHOOL

TEACHER CERTIFICATION/LICENSURE

READMISSION

UNDERGRADUATE INTERNATIONAL

Winston-Salem State University is committed to equality of educational opportunity and does not discriminate against applicants, students or employees based on race, color, national origin, religion, gender, age or disability. It is the policy of Winston-Salem State University to create diversity among its student body by recruiting and enrolling students without regard to race, gender or ethnicity. Applicants of all races, gender, and ethnic backgrounds are encouraged to apply for enrollment.

MAJORS1. Accounting2. African & African American Studies3. Art4. Biology5. Birth to Kindergarten Education 6a. Birth to Kindergarten Education – DL*6. Business Administration7. Chemistry8. Clinical Laboratory Science 9a. Clinical Laboratory Science – DL*9. Computer Science10. Economics11. Elementary Education12. English13. Exercise Science14. Finance15. Gerontology16. Health Care Management17. History18. Information Technology19. Interdisciplinary Studies 21a. Interdisciplinary Studies – DL*20. Justice Studies21. Management22. Management Information Systems23. Marketing24. Mass Communications25. Mathematics26. Motorsports Management27. Music28. Nursing 31a. RN-BSN – DL* option 31b. Accelerated Nursing (Second Degree Only)29. Physical Education30. Political Science31. Psychology32. Rehabilitation Studies33. Social Work34. Sociology35. Spanish36. Sport Management37. Teaching38. Therapeutic RecreationNOTE: *Distance Learning Options

APPLICATION CHECKLIST Freshman c Application for Undergraduate Admission c $50 Non-Refundable Application fee c OfficialHighSchoolTranscript(applicantsundertheageof21) c OfficialACTorSATtestscoreswithawritingscore(applicantsundertheageof21) c OfficialCollegeTranscript(ifapplicablefordualenrollmentcoursework) c Makecopiesofalldocumentssubmittedforreview

Transfer/(Second Degree)/Evening-Weekend/Teacher Certification/DistanceLearning c Application for Undergraduate Admission c $50 Non-Refundable Application fee c OfficialHighSchoolTranscripts(applicantsundertheageof21whohavenot obtained an Associates Degree) c OfficialACTorSATtestscoreswithawritingscore(applicantsundertheageof21 whohavenotobtainedanAssociatesDegree) c OfficialCollegeTranscripts(remembertosubmitatranscriptfromeachinstitution you have previously attended) c Makecopiesofalldocumentssubmittedforreview

International c Application for Undergraduate Admission c $50 Non-Refundable Application fee c OfficialHighSchoolTranscripts(applicantsundertheageof21) c Course-by-course credential evaluation by World Education Services or another internationalacademiccredentialevaluationservicefortransferswithcollege courseworkfrominstitutionsoutsideoftheU.S.A. c OfficialACTorSATtestscoreswithawritingscore(applicantsundertheageof21) c OfficialCollegeTranscripts(remembertosubmitatranscriptfromeachinstitution you have previously attended) c OfficialTestofEnglishasaForeignLanguage(TOEFL)scores c Certificateoffinancialresponsibilityanddocumentationshowingsufficientfinancial resources for the duration of the student’s stay in the United States of America c Proof of graduation from a secondary school c Makecopiesofalldocumentssubmittedforreview

Summer School Only – Visiting c Application for Undergraduate Admission c $50 Non-Refundable Application fee c Officialtranscriptfromthemostcurrentinstitution c Makecopiesofalldocumentssubmittedforreview

Non-Degree Seeking c Application for Undergraduate Admission c $50 Non-Refundable Application fee c Officialtranscriptfromthemostcurrentinstitution c Makecopiesofalldocumentssubmittedforreview

MAIL COMPLETED APPLICATION TO: 601 S. Martin Luther King, Jr. Drive, Anderson Center, Suite 137, Winston-Salem, NC 27110

FOR MORE INFORMATION, EMAIL: Admissions@wssu.edu

FRESHMAN REQUIREMENTSWinston-SalemStateUniversitydefinesa“freshman”asanystudentthathascompletedthenecessaryrequirementsfor graduationfromtheK-12systemorcompletionofahighschoolequivalenceprogram,andhasnotenrolledinatwoorfouryearcollege/university.WeinvitethesestudentstoapplytotheuniversityunderourFreshmanRequirements.

ThereareseveralfactorsthatwillbeusedtoevaluateapplicantsforadmissiontoWinston-SalemStateUniversity.Factorsusedto evaluate a student’s application are: Quality of High School Academics, Academic Achievement, Standardized Test Scores.

According to the University of North Carolina system, students applying for admission must provide evidence that they have completed or will complete the Minimum Course Requirements as listed below: • Four (4) units/years of college preparatory English • Four (4) units/years of Math • Algebra I • Geometry • Algebra II • A math course higher than Algebra II (For example: Pre-Calculus, Calculus, Statistics, Models & Functions, DifferentialEquationsandTrigonometry) • Three (3) units/years of Science • 1 unit/year of Biological Science • 1 unit/year of Physical Science • 1 units/year of an additional Science • Two (2) units/years of Social Science • 1 unit/year of American or U.S. History • 1unit/yearofacourseofyourchoosingintheSocialSciencefield • Two (2) units/years of the same Foreign Language

TRANSFER REQUIREMENTSWinston-SalemStateUniversitydefinesa“Transfer”asanystudentthathascompletedtherequirementsoftheK-12systemandhascontinuedtheireducationatatwoorfouryearcollege/universitypriortothesubmissionofanapplicationtoWSSU. • All transfers over the age of 21arerequiredtosubmitallofficialtranscriptsfromeachcollege/universityattended. • All transfers under the age of 21whohavenotobtainedanAssociatesdegreearerequiredtosubmitanofficialhigh school transcript, SAT/ACTscores,andofficialtranscriptsfromeachcollege/universityattended. • Alltransfersundertheageof21whodonotmeettheFreshmanadmissionrequirementsmusthaveearnedatleast 24 hours of college transferrable credit.

Transfer students should remember that: • Lettergradesof“C”orhighermustbeobtainedincollegelevelcourseworktobeconsideredfortransfercredit • Students must be in good academic and disciplinary standing at all previous institution(s) and eligible to return to the last institution attended • Must have a cumulative G.P.A. of 2.0 or higher on last institution attended • Tobeconsideredfortransfercredit,courseworkmustbecompletedataregionallyaccreditedinstitution.

SECOND BACCALAUREATE DEGREE SEEKING STUDENTS Winston-SalemStateUniversitydefinesa“SecondDegree”asanystudentthathaspreviouslycompletedtherequirementsandearned a Baccalaureate Degree. • Anearneddegreemustbereflectedonofficialtranscript • Mustsubmitofficialtranscriptsfromeach college/university attended

READMISSION: (FORMER WSSU STUDENTS ONLY) Studentswhohavebeendismissedordiscontinuedtheirundergraduatestudiesmaybeeligibleforreadmissiontothe university.Previousacademichistorywillberevieweduponreceiptofapplicationtodetermineeligibility. • Studentswhohave notattendedanothercollege/universitysinceleavingWSSUarenotrequiredtopayan application fee. • Studentswhohave attended another college/university since leaving WSSU must submit a $50 application fee, alongwithofficialtranscriptsfromtheotherinstitution(s). • If attended another college applicant must have obtained at least 2.0 GPA from the last attended institution.

NON-DEGREE SEEKING STUDENTS/TEACHER CERTIFICATION AND COMPUTER SCIENCE CERTIFICATION STUDENTS Eachsemester,individualshaveanopportunitytobeadmittedasNon-degreeseekingstudents,andacquireupto 12 credit hours. *Please note the following: • Winston-SalemStateUniversityassumesnoresponsibilityfordeterminingastudent’scourseselectionwhenthe credits are to be transferred to another institution. • Studentsarealsonoteligibleforfinancialaidunderthisstatus. • Creditsobtainedinthismannerwillnotcounttowardsadegreeuntilastudenthasmettheadmissionrequirements through the Freshman or Transfer process.

SUMMER SCHOOL APPLICANTS • AdmissiontoSummerSchool(SessionI&II)isopentovisitingstudentswhowishtoenrollatWSSUandwhointendto transfercoursesbacktotheir“home”institution. • Studentswhoareinterestedintakingclassestotransfertoothercolleges/universitiesshouldobtainapprovalfromtheir home institution of transfer credit prior to submission of an application. • High School seniors and juniors are eligible for summer enrollment. Possible candidates must display exceptional academic achievement that meet or exceed the standards of freshman admission. Students must provide a formal endorsement from their Principal on school letterhead. • First time freshmen are not eligible for summer school.

UPDATE ADMISSION:Wedonotallowstudentsto“update”applications.Studentsmustsubmitanewapplicationandpaythe$50applicationfee.

*Disclosure of the applicant social security number is voluntary, and is requested herein for record-keeping purposes. Please be aware that financial aid, employment, and reporting of tuition and related expenses for tax purposes cannot be processed without submission of a valid social security number.

Entry Term: m Fall (Aug-Dec) m Spring (Jan-May) m Summer I (May-Jul) m Summer II (Jun - Jul)

Student Type: c Freshman c Visiting c TeacherCertification/Licensure cNon-Degree c Transfer c Computer Sci. Cert. c Readmission c Second Degree cDistance Learning

INTENDED MAJOR Please refer to the opposite page for a list of majors. Themajoryouchoosedoesn’taffectouradmissiondecision;weuseittoassignyouradvisor.Write“undecided”ifyouareunsure.PLEASE NOTE: If you select Distance Learning, you must enroll in a distance learning program. c Birth to KIndergarten Education c Clinical Laboratory Science c Interdisciplinary Studies cRN-BSN

FULL LEGAL NAME (PLEASE PRINT):

Former last name (if applicable):

Birth Date: / / Gender: c Female c Male Place of birth:

Social Security #:Disclosureoftheapplicant’ssocialsecuritynumberisvoluntary,andisrequestedhereinforrecord-keepingpurposes.Pleasebeawarethatfinancialaid,employment,andreportingoftuitionandrelatedexpenses,fortaxpurposescannotbeprocessedwithoutsubmissionofavalidSocialSecuritynumber.

PARENT E-MAIL ADDRESS Wewillusethisfrequentlytosendyouimportantinformation. @

STUDENT E-MAIL ADDRESS Wewillusethisfrequentlytosendyouimportantinformation. @

MAILING ADDRESS Whereweshouldreachyoubetweennowandthebeginningofthesemester.Pleasenotifyusinwritingifthisaddresschanges.Address:

Country (if not U.S.): Permanent Phone: ( ) Cell Phone: ( )

Other Phone: ( )

PERMANENT ADDRESS pleasegiveyourcurrentmailingaddressforalladmissioncorrespondence.Pleasenotifyusinwritingifthisaddresschanges.

Current mailing address

ETHNICITY Howwouldyoudescribeyourself?Please check all that apply.AreyouHispanicorLatino?c Yes c NoRACE Selectoneormoreofthefollowingracialcategories.c American Indian or Alaska Native c Asianc Black or African American cNativeHawaiianorc White OtherPacificIslander

c I choose not to disclose this information

CITIZENSHIPc U.S. CitizencPermanentResidentAlien(hold“GreenCard”FormI-151)

c Non-Resident Alien #If you are a citizen of another county, you will need to file a financial certification form asrequired by law. For a copy, go to www.wssu.edu. Refer back to checklist.

Current visa status (check if applicable)c A c B-1/2* c F-1 c F-2 c J-1 c J-2 c G c H c PR c Other

Typeofvisarequesting (check if applicable)c A c F-1 c F-2 c J-1 c J-2 c G c H c PR c Other

LAST OR FAMILY

LAST

FIRST

FIRST

MIDDLE

MIDDLE

SUFFIX (JR., SR., ETC.)

SUFFIX (JR., SR., ETC.)

MONTH DAY YEAR CITY/STATE OR PROVINCE/COUNTRY

STREET ADDRESS OR PO BOX CITY STATE ZIP

AREA CODE AREA CODE

AREA CODE

NUMBER & STREET APARTMENT #

CITY/TOWN STATE/PROVINCE COUNTRY ZIP POSTAL CODE

STATE/PROVINCE

CITIZENSHIP COUNTRY

RECEIPT # DATE OF ISSUE

STATE OF RESIDENCE CITIZENSHIP COUNTRY

Residency Determination Service Your residency for tuition purposes determines your in-state or out-of-state status and may impact your admission, tuition, scholarship or financialaideligibility.NorthCarolinaresidencyfortutionpurposesisgovernedbyNorthCarolinastatelaw.MoreinformationaboutNorthCarolinaresidencyfortuitionpurposescanbefoundatwww.ncresidency.org.Do you claim to be a North Carolina Resident? cYesIclaimtobeaNorthCarolinaresidentfortuitionpurposes.* ResidencyCertificationNumberc No I do not claim to be a North Carolina resident for tuition purposes. IunderstandIwillbechargedthenon-residenttutitionrateifenrolledat a North Carolina state-supported institution.*Ifyouclaimtobearesident,youmustcompletetheresidencyprocesswiththeResidency DeterminationService(RDS)atwww.ncresidency.org.YouwillreceiveaResidencyCertification (RCN)whichshouldeitherbeenteredontoyouradmissionsapplicationorprovideddirectlyto yourAdmissionsOffice,whenavailalbe.

EMERGENCY CONTACT: RELATIONSHIP:

Home phone: ( ) Work: ( )

LAST NAME FIRST

AREA CODE AREA CODE

MAIL COMPLETED APPLICATION TO: 601 S. Martin Luther King, Jr. Drive, Anderson Center, Suite 137, Winston-Salem, NC 27110

APPLICANT CERTIFICATION In an effort to maintain a safe learning community, we must ask the following questions of all applicants. For the purpose of the following questions, “crime” or “criminal charge” refers to any crime other than a traffic related misdemeanor or an infraction. You must, however, include any alcohol or drug related offenses whether or not they are traffic related incidents. Answering “yes” to any of the following questions may not necessarily preclude your being admitted. However, failing to answer these questions, or failing to respond completely, accurately, and truthfully, may be grounds to deny or withdraw your admission or to dismiss you after enrollment.

If you answer “yes” to any of these questions, please provide a written explanation that gives the approximate date of each incident, explains the circumstances, and reflects on what you learned from the experience. The university reserves the right to require an additional statement from an appropriate official corroborating your account, either before acting on your application or before permitting you to enroll. Your failure to provide such a statement upon request may be grounds to deny or withdraw your admission or to dismiss you after enrollment.

You are required to notify the university immediately and in writing of any new or pending criminal charge, any disposition of a criminal charge, or any school, college, or university disciplinary action against you, or any type of military discharge other than an honorable discharge, or any non-routine absence from school, that occurs at any time after you submit this application and prior to enrollment. Your failure to do so may be grounds to deny or withdraw your admission or to dismiss you after enrollment.

1. c Yes c No Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution?

2. c Yes c No Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? [Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]

3. c Yes c No Do you have any criminal charges pending against you?

4. c Yes c No Have you entered a plea of no contest or nolo contendere, or an Alford plea, to a misdemeanor, felony, or other criminal charge; or received a deferred prosecution or prayer for judgment continued for such a charge; or otherwise accepted responsibility for such a crime?

5. c Yes Have you received any type of discharge from military service “other than an honorable discharge”? c No - Never Served c No - Currently Serving c No - Honorably Discharged

6. c Yes c No If your education was or will be interrupted, indicate here and provide details in the ADDITIONAL INFORMATION SECTION.

I hereby acknowledge that WSSU may verify the information set forth herein from sources permitted under law and that the institution may divulge the contents of this application only as permitted under the Family Educational Rights and Privacy Act of 1974, if I am or have been in attendance at this institution.

I understand my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after enrollment.

Signature of Applicant Date

If applicant is under 18 years of age, signature of parent or guardian Date

ACADEMIC INFORMATIONDid you receive a general education development certificate or adult high school diploma? c Yes, c No c N/A

High School Information

Date of High School Graduation:List all colleges/universities you have ever attended for any length of time. (list most recent first and attach an additional sheet if necessary)

Is Winston-Salem State University your first choice? c Yes c No If no, please indicate your first, second and third choices:

1. 2. 3.

PARENT INFORMATIONHighest level of education: Parent 1 Parent 2

MONTH / YEAR

HIGH SCHOOL ADDRESS DATES ATTENDED

COLLEGE / UNIVERSITY

COLLEGE / UNIVERSITY

COLLEGE / UNIVERSITY

ADDRESS

ADDRESS

ADDRESS

DEGREE EARNEDDATES ATTENDED (MONTH / YEAR)

DEGREE EARNED

DEGREE EARNED

DATES ATTENDED (MONTH / YEAR)

DATES ATTENDED (MONTH / YEAR)

Graduated? c Yes c No

MILITARY STATUSa. AreyoucurrentlyservingorhaveyoueverservedintheUnitedStatesArmedForces? c No c Yes b. AreyouadependantorspouseofacurrentorpriorUnitedStatesservicemember? c No c Yes

Ifyouansweredyestoquestion(a)above,pleaseanswerthefollowing:

1. Your Current Status: c Active Duty c NC National Guard cOther National Guard c Reservist c Separated Veteran c Retiree

2. Branch of Service: c Army c Air Force cMarine Corps c Navy c Coast Guard

3. Current or Last Pay Grade: c E-1 c E-2 c E-3 c E-4 c E-5 c E-6 c E-7 c E-8 c E-9 c O-1 c O-2 c O-3 c O-4 c O-5 c O-6 c O-7 c O-8 c O-9 c O-10 c O-11 c W-1 c W-2 c W-3 c W-4 c W-5

4. Doyouplantousemilitaryorveteranseducationalbenefitswhileenrolledatthisinstitution?c No c Yes c Not Sure

Ifyes,whichbenefitdoyouplantouse? c Chapter 30 – Montgomery GI Bill c Chapter 31 – Vocational Rehabilitation c Chapter 33 – Post 9/11 GI Bill c Chapter 35 – Dependents Education Assistance (DEA) c Chapter 1606 – Selected Reserves GI Bill c Chapter 1607 – Reserves Education Assistance Program (REAP) c Military Tuition Assistance c Military Spouse Career Advancement Accounts (MyCAA) c Marine Gunnery Sgt. John David Fry Scholarship c Not Sure

5. Your current or last permanent duty station: c Fort Bragg c Camp Lejeune c MCAS Cherry Point c MCASNewRiver c PopeArmyAirfieldc Seymour Johnson AFB c USCG North Carolina c Other installation outside of NC c NC National Guard c Other National Guard c Reservist

6. Your current or last home of record:

7. YourstateoflegalresidencelastclaimedonyourDDForm2058(StateofLegalResidenceCertificate)

8. Date of initial entry into military service:

9. Discharge or retirement date (actual or anticipated):

10. Ifdischarged,yourfinaldutystation:c Fort Bragg c Camp Lejeune c MCAS Cherry Point c MCASNewRiver c PopeArmyAirfieldc Seymour Johnson AFB c USCG North Carolina c Other installation outside of NC c NC National Guard c Other National Guard c Reservist

Ifyouansweredyestoquestion(b):PleasecompletethefollowingifyouarethedependentorspouseofsomeonecurrentlyservingorwhohaseverservedinanybranchorstatusintheUnitedStatesArmedForces.Thisinformationwillhelpusconnectyouwithfinancialaidbenefitsanddetermineyoureligibilityforin-stateresidency.

1. Your relationship to the service member or veteran: c Dependent c Spouse

2. Current Status of Service Member: c Active Duty c NC National Guard c Other National Guard c Reservist c Separated Veteran c Retiree

3. Branch of Service: c Army cAir Force c Marine Corps c Navy c Coast Guard

4. Current or Last Pay Grade of Service Member: c E-1 c E-2 c E-3 c E-4 c E-5 c E-6 c E-7 c E-8 c E-9 c O-1 c O-2 c O-3 c O-4 c O-5 c O-6 c O-7 c O-8 c O-9 c O-10 c O-11 c W-1 c W-2 c W-3 c W-4 cW-5

5. Doyouplantousemilitaryorveteranseducationalbenefitswhileenrolledatthisinstitution?cNo c Yes c Not Sure

MILITARY STATUSIfyes,whichbenefitdoyouplantouse? c Chapter 30 – Montgomery GI Bill c Chapter 31 – Vocational Rehabilitation c Chapter 33 – Post 9/11 GI Bill c Chapter 35 – Dependents Education Assistance (DEA) c Chapter 1606 – Selected Reserves GI Bill c Chapter 1607 – Reserves Education Assistance Program (REAP) c Military Tuition Assistance c Military Spouse Career Advancement Accounts (MyCAA) c Marine Gunnery Sgt. John David Fry Scholarship c Not Sure

6. Current or last permanent duty station of service member: c Fort Bragg c Camp Lejeune c MCAS Cherry Point c MCASNewRiver c PopeArmyAirfieldc Seymour Johnson AFB c USCG North Carolina c Other installation outside of NC c NC National Guard c Other National Guard c Reservist

7. Current or last home of record of service member:

8. Whatis/wasthestateoflegalresidencelastclaimedonhis/herDDForm2058(StateofLegalResidenceCertificate)?

9. Date of initial entry into military service for the service member:

10. Discharge or retirement date of service member (actual or anticipated):

11. Ifdischargedorretired,servicemember’sfinaldutystation:c Fort Bragg c Camp Lejeune c MCAS Cherry Point c MCASNewRiver c PopeArmyAirfieldc Seymour Johnson AFB c USCG North Carolina c Other installation outside of NC c NC National Guard c Other National Guard c Reservist

ADDITIONAL INFORMATION SECTION

January 2017

601 S. Martin Luther King, Jr. Drive Anderson Center, Suite 137 Winston-Salem, NC 27110