Shepherdstown   |   Martinsburg    
 

APPLICATION FOR ADMISSION -- 006 MARTINSBURG CENTER


1. Name and Address


Student Name





Yes No






Permanent Address








Mailing Address (if different)








Contact Information





2. Personal Information


Male Female
Yes No

American Indian/Native Alaskan
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White

American Indian/Native Alaskan
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
Yes No

These questions are strictly optional and will in now way affect the decision of whether to admit any applicant. Shepherd University requests that these questions be completed to assist the college in complying with its obligations under state and federal law to attempt to collect this data and to periodically report the statistical totals in various reports, including the annual EEO/AA Plan published by the Affirmative Action Officer.

Citizenship Information

Yes No


Miscellaneous Information

Yes No


Emergency Contact Information










3. Enrollment Information


Spring 2015 Summer 2015

Freshman
Early Admissions
Honors Program
Readmit (Semester and year last enrolled)
Transfer
Transient
Yes No
Regents Bachelor of Arts
Registered Nurse to Bachelor of Science in Nursing
Bachelor of Arts in Early Education

Additional Information


Academic Information





Yes No

4. College Information


All transfer applicants--including high school students who have taken college classes--must complete this section. Transfer students must have two (2) official transcripts sent to the Office of Admissions from each college previously attended. Incomplete information may result in disciplinary action or denial of admission.

Yes No

List all colleges you have attended and the hours/degrees earned, beginning with the most recent:

















Miscellaneous Information

Yes No
Yes No


Comments or Questions



Refer a Friend

Who do you know that could be a good fit to take classes at the Shepherd University Martinsburg Center? Please list their contact information below and we will make sure they receive information.








Yes No

Martinsburg Center | 261 Aikens Center | Martinsburg, West Virginia | 25404-6203 | 304-263-3303 | FAX 304-551-0089