Transient Student Application for Admission

Social Security Number


Optional:  in accordance with the Privacy Act of 1974, you are not required to give your Social Security Number.  The number is required for financial aid purposes.
FULL LEGAL NAME
*Last Name
*First Name
Middle Name
Other Last Name on Transcript
*Sex
*Date of Birth Year: 
*Place of Birth
*Country of Citizenship
Ethnic Origin Are you Hispanic or Latino? 
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White

(Ethnic origin information is voluntary and will not be used in a discriminatory manner.)
PRESENT ADDRESS
*Address
*City
County
*State
*Zip (example - 35470)
*Phone
*Email
PERMANENT ADDRESS (if different from present)
Address
City
County
State
Zip (example - 35470)
PARENT/GUARDIAN INFORMATION
*Name
*Relationship to Applicant
*Phone
ENROLLMENT INFORMATION
*Term of Attendance  
*Classification
Academic Program at your current institution
HIGH SCHOOL INFORMATION
*High School Name
*City
*State
*Graduation Date
COLLEGE INFORMATION
List all Colleges attended: (If you have previously attended UWA, please list below:
College
Location
Dates of Attendance
Degree Earned

College
Location
Dates of Attendance
Degree Earned

*Are you currently enrolled in college?
If currently enrolled, where?
Are you presently eligible to re-enter the last institutional you attended?
RESIDENCY
Please check the appropriate statement
I am a permanent resident of Alabama or one of the following counties in Mississippi:  Clarke, Kemper, Lauderdale, Jasper, Neshoba, Newton, Noxubee, or Winston

The State of Alabama Legislative Act 91-584 states that "No person who is required to register with the Selective Service System shall be eligible to enroll in any state postsecondary institution of higher learning within the State of Alabama without proof of such registration.  By signing this application below, I certify that I comply with the provisions of the United States Military Selective Act by meeting one of the following requirements:  (1)  I have registered with the Selective Service Board, or (2) I am not 18 years of age and I will register when required, or (3) I am not required by law to register.

I hereby affirm that all information in these blanks is complete and accurate. I understand that withholding information requested or giving false information may make me ineligible for admission and is reason for termination with loss of credit.


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The University of West Alabama does not discriminate on the basis of race, color,
national origin, gender, religion, age, disability, or sexual orientation in employment or the provision of services.
Send questions or comments to: admissions@uwa.edu
Last revised: October 14, 2019