Permanent Mailing Address:

City State Zip Code + 4

County of Residence:

Country of Residence:

Telephone Number (include area code):

Citizenship:

U.S. citizen


Resident Alien/Permanent U.S. Resident

Resident Alien Number

A Photocopy of the applicant's permanent resident card is required to complete the application process.


Non-resident Alien (Foreign National)note: If this option is checked, please email Averett University for a printed version of the International Application for Admission

Country of Citizenship, if not U.S.

Social Security Number:

Gender: Male Female

Date of Birth (Month/Day/Year):

Place of Birth (City, State, Country):

Former Name(s), if any:

Work Phone Number:

Marital status:No Responsesinglemarriedseparatedwidoweddivorced

Height: feet, inchesWeight: pounds

Ethnic Origin:No ResponseBlack, Non-HispanicWhite, Non-HispanicAmerican IndianAlaskan NativeAsianPacific IslanderHispanic

Religious Affiliation: No Preference Baptist Church of the Brethren Episcopalian Jewish Lutheran Presbyterian Methodist United MethodistChurch of Christ Mennonite Roman Catholic Other

If Aeronautics is your chosen major, you must indicate a concentration:

Aviation Business

Flight Operations

Aviation Technical Systems

Aviation Maintenance Operations (transfer only)

If Equestrian Studies is your chosen major, you must indicate a concentration:

Equine Management

Eventing Instruction

Dressage Instruction

Professional Objective:

If Education is your chosen major, check which grade level:

Elementary (Pre K-6)

Secondary (6-12)

If Secondary, which subject?

Anticipated Degree:Associate of ArtsAssociate of ScienceBachelor of Applied ScienceBachelor of ArtsBachelor of Business AdministrationBachelor of ScienceMaster of Arts in TeachingMaster of Business AdministrationMaster of Education

Term and Year you plan to enter Averett University:

Fall Spring Summer I Summer II

Year:

Status: Full-time Part-time (fewer than 12 hours)

Classification:Check all that apply.

New Freshman

Transfer (12 or more college credits attempted post high school)

IDEAL

Audit

Readmit (List last term and year attended.)

 (Contact the Registrar's Office for readmission procedures)

Special (no degree objective)

If Special, do you plan to become a degree-seeking student at Averett in the future?

Yes No

Residence: On-Campus ResidentCommuter

Name: Relationship:

Year(s) Attended/Graduated:

Name: Relationship:

Year(s) Attended/Graduated:

How did you first hear about Averett?

Are you a U.S. Veteran? Yes No

Will you be receiving Veteran's benefits to attend college? Yes No

Education Information

GED?YesNo

If Yes, send your GED Certificate, Test Scores, and H.S. Transcripts up to the time of withdrawal to the Averett Admissions Office.

List below the date(s) you have taken or plan to take the SAT I or ACT:

SAT I: mth/yrmth/yrmth/yrmth/yr

ACT:mth/yrmth/yr mth/yrmth/yr

List any leadership position, honor designation, and examples of extracurricular and community activities: (sports, clubs, plays, publications, volunteer work, etc.) - Enter 'Not Applicable' if you have none

List the accomplishments of which you are most proud :

List the most interesting course you have taken and why :





Do you plan to participate in intercollegiate sports at Averett?

Yes No

If Yes, which sport(s)?



List all colleges to which you will apply:





Have you previously applied for admission to Averett? Yes No

If yes, give term and year:

Name under which you applied:

Transfer Information

Have you attended another college/university?YesNo

If yes, complete the following section and list all current and previous college/university work whether or not transfer credit is desired or applicable.

Family Information:

Application Procedures

Averett University does not discriminate on the basis of race, color, creed, age, gender, national origin or disability in the administration of any of its educational programs, activities, admissions or employment practices.