ONLINE UNDERGRADUATE APPLICATION FORM



 

Freshman Applicants
Please call 1.888.359.5782

  • A completed application (online or regular) - Please call 1.888.359.5782 for assistance
  • Official high school transcript(s)
  • Results of either an ACT or SAT examination if you are an athlete (applicants holding a high school equivalency diploma may submit official results of a G.E.D. examination in place of high school transcripts and ACT/SAT scores)
  • A $20 application fee (call 1.888.359.5782 for details)

Transfer Applicants
Please call 1.888.359.5782 for assistance

  • All of the items listed above in the instructions to Freshman Applicants
  • Official academic transcripts from each college/university you have attended or are currently attending
  • Transfer Student Personnel Records from each college/university you have attended (upon receipt of your application, the Salem International University Office of Admissions will send you one personnel record form for each college/university listed on your application. It is your responsibility to have those forms completed and returned to Salem International University)
  • Financial Aid transcripts must be mailed to the Salem International University Office of Admissions
  • A $20 application fee (call 1.888.359.5782 for details)
 
RED indicates a required field.
PERSONAL INFORMATION
First Name:
Middle Name:
Last Name:
Birth Date: / /
Social Security Number:
NOTE: If Social Security Field is left blank you will be contacted by an admissions counselor for this information.
E-mail Address: 
Home Phone: ( )
Sex:
Marital Status:
Are you a US Citizen?
Are you a permanent US Resident?
If your answer was NO to both questions above you are filling out a wrong application. Click here to get to the right application.
Ethnic Origin (This question is optional and is used for statistical purposes only):
PERMANENT ADDRESS INFORMATION
Number and Street:
City:
State County:
State:
Zip:
MAILING ADDRESS INFORMATION
Same as Permanent Address
Number and Street:
City:
State County: State:
Zip:
If mailing address is different than permanent address, include dates - FROM:
TO:
ENROLLMENT INFORMATION
NOTE: Choose Special Student Status only if you are a non-degree seeking student!
  I intend to be enrolled primarily
I am applying for enrollment in:
I am applying for:  status.
Have you ever applied to S-TU or SIU?:
If Yes, when?:
College Residence:
Intended Major:
BILLING INFORMATION Same as Permanent Address
Name:
Phone: ( )
Number and Street:
City:
State County: State:
Zip:
PARENT, GUARDIAN INFORMATION
Does either parent have a 4 year Degree?
Mr. Mrs. Dr. Ms. Mr. & Mrs. Dr. & Mrs. Rev. & Mrs.
First Name: Middle Name:
Last Name:
FATHER'S OCCUPATION INFORMATION
Position:
Employer: City:
State:
MOTHER'S OCCUPATION INFORMATION
Position:
Employer: City:
State:
GUARDIAN'S OCCUPATION INFORMATION
Position:
Employer: City:
State:
FINANCIAL AID INFORMATION
Will you be applying for financial aid?:
Has your FAFSA been mailed to the U.S. Department of Education?:
If Yes, when?: / /
PREVIOUS EDUCATION INFORMATION
Secondary Schools
List all secondary schools, beginning with the most recent, and include date(s) of graduation and anticipated date of graduation.

I have a GED

 HIGH SCHOOL GPA
1. School: from: /
to: /
  City: State:
Date of Graduation:
2. School: from: /
to: /
  City: State:
Date of Graduation:
3. School: from: /
to: /
  City: State:
Date of Graduation:
Colleges and Universities
List all colleges and universities attended, beginning with the most recent.

COLLEGE GPA
1. College/Univ.: from: /
to: /
City: State:
Date of Graduation:
2. College/Univ.: from: /
to: /
City: State:
Date of Graduation:
3. College/Univ.: from: /
to: /
  City: State:
Date of Graduation:
References
Please list three references. One must be your guidance counselor, one your English teacher, and one of your choice.
1. Name: Position:
Phone (w):
2. Name: Position:
Phone (w):
3. Name: Position:
Phone (w):
OTHER INFORMATION
Have you ever been dismissed or placed on probation by any high school or institution of higher education?:
If yes please explain:
Have you ever been convicted of a felony:
If yes please explain:
Do you have any special needs or requirements:
List academic Honors Earned (Honor Societies, etc.):

Indicate activities, offices held in high school and years of participation (Sports, Student Government, Publications, Music, Theater, Civic Groups, etc.):

To which other colleges do you plan to apply for admission?

List in order of their importance, the influences that led you to apply to Salem International University:

Notice to Prospective Students

Notice of Availability of Campus Security Reports

As provided by the Jeane Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act of 1998, prospective students are entitled to request and receive a copy
of the Security Report of any campus of the University they are interested in attending.
Each Security Report includes statistics for the past three years concerning crimes and incidents (whether they occurred on campus, in off-campus buildings or property owned or controlled by the University, or on public property adjacent to campus) reported to campus security authorities. Each report also provides campus policies and practices concerning security, how to report sexual assault and other crimes, crime prevention efforts, policies/
laws governing alcohol and drugs, victims' assistance programs, student discipline, campus resources, and other matters.

Security Reports for the University are available online through the following University
wide link: http://www.salemiu.edu/campus_life/safety/index.shtml

If you do not have access to the Internet, you may obtain a copy of the Security Report
for the campus by submitting a request in writing directly to: Jerry Schearer, Clery Act Compliance Officer, Campus Box U, PO Box 500, Salem, WV 26426.
APPLICATION AGREEMENT

I certify this information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any schools or colleges I have previously attended to release personal and academic information to Salem International University. Further, I agree that my college grades be used for statistical studies or sent to my high school or junior college for evaluation purposes. I understand that official high school (or college) transcripts and results of an ACT or SAT examination must be sent to the Office of Admissions before an admission decision can be made.
Check the box if you agree with the statement above:
Today's Date: / /