TEXAS SOUTHERN UNIVERSITY
APPLICATION FOR ADMISSION TO THE GRADUATE SCHOOL

Social Security Number Legal Name (Last)

Office Use Only (First) MO DAY (Middle (City) (City)

Check the term of Entry (one box only Former name (State) (State)

Fall

Spr Sex (optional) (Zip) (Zip)

Sum l

Sum ll

Date of Birth – Mo Day Year Home Phone Business phone

Mailing address (Number and Street) Permanent address (Number and Street) Place of birth (City) (State)

(County)

Are you a legal resident of Texas? Yes No

Are you a veteran? Yes No How long have you resided in Texas? From To

E-mail Address: Country of citizenship Type of visa if not US citizen

Ethnicity (Optional) This information is used for statistical purposes. White Asian or Pacific Islander (AP) Black/African American Chinese Samoan Indian (American) Filipino Asian Indian Japanese Hawaiian Korea Guamanian Mexican American Vietnamese Other AP (Print group) Latino Other Race (please print) Name and address of parent or alternative contact Have you previously applied for If yes, Year Department Admission to graduate status at Yes No Texas Southern University? Have you ever enrolled for If yes, From: To: Undergraduate Student Student Number, if any credit courses at Texas Yes No Graduate Student Southern University? List names of all colleges schools attended including Texas Southern University College or school name Location Dates Degree and date received or expected City State

Check box if you have taken or plan to take the following tests. Graduate Record Examination Test of English as a Foreign Language Graduate Management Admissions Tests

Date Score:

List all jobs held during the past 12 months beginning with the most recent position. Name of Company, Agency of Organization City State Zip From: Mo. /Yr. To: Mo. /Yr.

Attach a sheet if additional space is required.

**Student