MICHIGAN UNIFORM UNDERGRADUATE GUEST APPLICATION

1. Name________________________________________________________ 2. Social Security No. _____________________
                Last                         First                                        Middle
3. Sex* M/F    4. Birth Date *____________________ 5.Citizenship____________________(Visa Type)_________________
                                                                                                                                Country
6a. Racial/Ethnic Background* - please check only ONE category which best applies to you:
      __ Hispanic __ White (non-Hispanic) __ Black (non-Hispanic) ___ Am.Indian,Eskimo or Aleut (AIEA) __ Asian or Pacific Islander (API)
6b. Are you MULTIRACIAL? Yes    No
       If you answer “Yes,” please mark all of the races below that apply to you based on the list from Item 6a:
      __ Hispanic __ White (non-Hispanic) __ Black (non-Hispanic) ___ Am.Indian,Eskimo or Aleut (AIEA) __ Asian or Pacific Islander (API)
         NOTE: For purposes of this question, you are Multiracial if you have parents from more than one of the broad race categories listed in item
                      6a OR if at least one of your parents is Multiracial.

7. Current Address___________________________________________________________ Phone(______)_________________
No. Street City State Zip

8. Home Address_____________________________________________________________ Phone(______)__________________
No. Street City State Zip

9. High School_______________________________________________________ Graduation Date_________________________
Name City State

10. State of Legal Residence__________________________________ Country of Legal Residence___________________________

The above has been my legal residence since___________________________________________________________________

11. Guest Application to _____________________________________________________________________________________
                                                                     College or University                                                           City
12. Guest Term Dates________________________________________ to_______________________________________________
                                                                Month/Year                                                                            Month/Year
13. Have you previously applied for admission to this institution?        Yes        No
14. Have you previously attended classes at this institution?        Yes        No
        If yes, indicate attendance dates___________________________ to_______________________________
                                                                       Month/Year                                            Month/Year

15. Classes Planned to Take _____________________________________________________________________________________
                                                                       Course Number                                                       Title
I certify that the above statements are true. I agree to abide by the regulations of the institution named above while I am enrolled.
I authorize the release of any records from my home institution which the guest institution ;may require

____________________________________________________________________________________________________________
Student’s Signature Date
* Optional and for Identification Purposes Only

1. Institution currently or Last Enrolled ________________________________________________________________________
                                                                                  College or University (Home Institution)
2. Enrollment Status:         Currently Enrolled?     Yes    No          Last Date of Attendance ______________________________
3. Standing:      “C” Average or better?      Yes       No       Eligible to Return?        Yes       No
I certify that the statements in Part II are true.

____________________________________________________________________________________________________________
Signature                                  Title                         Date                                         Phone No.                                Seal
                                NOT OFFICIAL WITHOUT COLLEGE/UNIVERSITY SEAL

MICHIGAN UNIFORM UNDERGRADUATE GUEST APPLICATION INSTRUCTIONS

This form will serve as your application for admission as a guest student at a Michigan College or university. All prospective students should check with the Guest Institution to determine if additional requirements are required for admission or enrollment. This form does not ensure transferability of courses taken at the Guest Institution to the Home Institution.

Fill out Part I of the Application. Then take it to the Registrar (or the officer at your school who processes Guest Applications) where Part II will be completed and signed. The completed Guest Application will be sent from the Home Institution to the school to which you are applying.

Guest Students…

1. are subject to all the admission and registration regulations of the Guest Institution.

2. do not have permission to register as a degree candidate at the Guest Institution.

3. are responsible to determine that the Home Institution will accept credit earned as a guest student.

4. must understand that falsification of any part of a Guest Application may result in cancellation of admission
and/or registration at the Guest Institution.

5. must arrange to have a transcript of any guest credit earned as a guest student sent from the Guest Institution
back to the Home Institution.

6. wishing to apply for financial aid should verify their eligibility with the Guest Institution.

Revised (03/00)