Non-degree Application Form


* Required Information
Personal Data    

*Social Security
Number
(###-##-####)

*Gender Female  Male  
*Date of Birth

 

*Last Name

*First Name  

*Middle Initial

Maiden Name  
*Permanent Mailing
Address

*City  

*State

*Zip Code  

Country

 *County  

*Home Phone
(###)###-####

E-mail address  
Fax Number
(###)###-####

Cell Number
(###)###-#### 		 
Racial/Ethnic
Background (optional)

 

*Citizenship

For Non US Citizens:  
Date you Entered US Country(s) of Citzenship  
Type of Visa Visa Date  

    

  
High School Background    
School Name Location (City, State) Date Attended    
   
   
 
     

If you did not graduate from high school do you have a GED? 
Yes  No

 
If yes, Where taken  
Date GED Received  
         
College Background
Undergraduate and graduate colleges attended, beginning with the most
recent. Enter "U" for undergraduate, "G" for graduate or "S" for summer
session attendance in the box marked "Type"		  
Colleges Attended / Type State / Major Dates of
attendances
(from/to)		 Degree Granted  
/ /  
/ /  
/ /  
         
         
Academic Plans  

*I plan to enter Trine University beginning

 

*I wish to apply for admission
to Trine University as a
Nondegree student in the school of:

 

*Please Check One:

Guest Student (enrolled at another college/university)
Plan to seek a degree at Trine at a later time
Taking a class for personal enrichment
 

 

I certify that the information provided is true and correct. I further agree to release information about myself and my academic record to Trine University if requested.