Application for Admission Social Security Number * Last Name * First Name * Middle/Maiden Mailing Address * City * State * Zip * County * Home Phone Number Cell Phone Number Date of Birth * Place of Birth (City, State) * Email Address * Enrolling for * Fall Spring Summer Enrollment Year * Which UAHT campus do you plan to attend? * Hope Texarkana Both Resident Status Have You resided in Arkansas for the last 6 months? * Yes No Have You resided in Hempstead County for the last 90 days? * Yes No Are you a United States Citizen? * Yes No Are you a permanent U.S. Resident? Yes No Ethnic Origin Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander American Indian or Alaska Native White Two or more races, mark all races that apply Sex Male Female Admission Status * First Time Freshman (First-time attending any college AFTER high school) High School/Concurrent (High school student taking classes on a high school or UAHT campus) Visiting Student (Degree seeking at another institution) Transfer (Degree seeking at UAHT and attended another institution previously) Non-Degree Seeking (Not seeking a degree at UAHT) Re-Admittance (Have attended UAHT before, after high school graduation) High School Graduate Year High School Attended GED Year State Issuing GED Transfer from Other Arkansas College/University Transfer from Out-of-State College/University List all colleges and universities previously attended in order of attendance College/University Date of Attendance Credit Hours Earned College/University Date of Attendance Credit Hours Earned College/University Date of Attendance Credit Hours Earned Have you attended UAHT before? * Yes No What year(s)? Student Level First Year (0-29 hours) Second Year (30-64 hours) College Graduate Other Degree Sought Associate of Arts - Transfer for All Majors Associate of Arts - Criminal Justice Focus Associate of Arts - Human Services Focus Associate of Arts - UAMS Track Associate of Science in Business Associate of Applied Science in Business Admin Associate of Applied Science in Crime Scene Associate of Applied Science in Early Childhood Ed Associate of Applied Science in Funeral Service Ed Associate of Applied Science in General Technology Associate of Applied Science in Information Technology Associate of Applied Science in Law Enforcement Admin Associate of Applied Science in Medical Office Management Associate of Applied Science in Nursing - (ARNEC) Associate of Applied Science in Paramedic Associate of Applied Science in Power Plant Technology Associate of Applied Science in Supply Chain Management Associate of General Studies (not transferrable) Associate of Applied Science, General Technology To select multiple hold down Ctrl key and select with mouse OR Technical Certificate Sought Accounting Business Administration Commercial and Residential Equipment Maintenance & Repair Crime Scene Investigation Diesel Technology - Basic and Advanced Funeral Directing Health Professions Heating, Ventilation & Air Conditioning Industrial Electricity Industrial Maint. Technology - Machining or Multi-Craft Information Technology Law Enforcement Administration Medical Office Management Paramedic Power Plant Technology Practical Nursing Supply Chain Management Welding Technology To select multiple hold down Ctrl key and select with mouse OR Certificate of Proficiency Sought Building Maintenance Child Development Associate Certified Nursing Assistant Crime Scene Investigation Diesel Technology - Brakes/Power Trains Diesel Technology - Electrical Systems Diesel Technology - Chassis Systems Diesel Technology - Engine Systems Emergency Medical Technician - Basic Heating, Ventilation, and Air Conditioning Industrial Technology - Mechanical Information Technology Law Enforcement Administration Major Appliances Medical Office Management Power Plant Operations Power Plant Technology Supply Chain Management Welding Technology - Basic Welding Technology - Construction Welding To select multiple hold down Ctrl key and select with mouse If your degree intent is other than listed above, please specify When you complete your degree at UAHT, do you plan to transfer to another institution? Yes No If yes, which institution do you plan on transferring to? Did either of your parents complete a four-year college degree? * Mother Father Both Neither Are you a convicted sex offender? * Yes No Indicate by submitting this form that you have read and understood all of the information on this application and the information you have provided is factually correct and honestly prepared. Full-time students are required to submit proof of measles and rubella immunization prior to admission. Failure to provide this proof of immunization will result in your being withdrawn from the courses in which you are enrolled. The UACCH College Catalog provides all of the policies and procedures students are required to follow. Please obtain a copy of the Catalog and be familiar with its contents.