2022 BSN

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Preferred Housing

Personal Data

Preferred Name

First Name

Middle Name

Last Name

Former Last Name (if we will receive transcripts and other records in this name)

Birthdate

Contact Information

Country

Street

City

Region

Postal Code

Cell Phone

Home Phone Number

Email Address

Education

Preferred Entry Term

Please indicate the college you attended most recently first.

College One

CEEB One

From

Please upload unofficial transcripts here for earlier review. We will need official transcripts to complete the admissions process.

Do you have additional schools you would like to enter?

Yes

College Two

CEEB Two

From

Please upload unofficial transcripts here for earlier review. We will need official transcripts to complete the admissions process.

Do you have additional schools you would like to enter?

Yes

College Three

CEEB Three

From

Please upload unofficial transcripts here for earlier review. We will need official transcripts to complete the admissions process.

Do you currently hold your Registered Nurse license?

Yes

Please upload a copy of your RN License here.

If no, when do you expect to receive it?

Are you currently employed?

Yes

Employment Information

Occupation (Title)

Employer

Do you plan to utilize tuition reimbursement from your employer?

Yes

Demographics

What is your primary citizenship?

Are you of Hispanic or Latino origin?

Yes

Regardless of your answer to the prior question, please indicate how you identify yourself?

What is your gender?

Male

Female

If you would like the opportunity, we invite you to share more about your gender identity below.

Additional Information

Have you previously applied to or attended the University of Mary Washington?

Yes

The University of Mary Washington is dedicated to providing our military service members with as many resources as possible to assist in furthering their education. Please honor us by providing information about your service affiliation to assist us in planning.

Please tell us which branch of the service your affiliation is with.

Do you wish to be considered for in state tuition?

Yes

Section A-Student Information

How long have you lived in the state of Virginia?

less than a year

one year

less than two years

two years or more

Where have you lived in the sense of physical presence during the last two years. Please list current address first.

Country

Street

City

Region

Postal Code

From:

To:

Did you live at this address two years or more?

yes

You have indicated that you lived at the previous address less than two years. Please indicate your address before this time.

Country

Street

City

Region

Postal Code

Please provide employment information for at least one year prior to the date for which in state tuition rates are sought.

Are you currently employed?

Yes

If you are not currently employed, please describe your present situation.

Name of Employer

Country

City

Region

Postal Code

Were you employed here for at least two years?

Yes

You have indicated that you were employed less than two years. Please indicate your employment before this time.

Name of Employer:

Country

City

Region

Postal Code

If you are married, do you wish to claim eligibility for in-state tuition rates based on your spouse’s domicile?

yes

n/a

Do any of the following characteristics apply to you?

Please check all that apply:

N/A

Age 24 or older as of the first day of the term in which you intend to enroll.

Veteran or active duty member of the U.S. Armed Forces.

Graduate or first-professional student.

Ward of the court or was a ward of the court until age 18

If both parents are deceased, no adoptive or legal guardian

Legal dependents other than a spouse

In the last tax year did you file a state return to any state other than Virginia?

yes

Please explain:

For at least one year immediately prior to the term in which you are claiming in-state status, will you have filed a tax return or paid income taxes to Virginia on all earned income?

yes

Please explain:

Are you a registered voter in Virginia?

yes

Are you registered in another state?

Yes

Original Date Registered

Do you hold a valid Virginia driver's license?

Yes

Original Date Registered

Renewal

If you hold a valid license in another state, please tell us which state.

Did you own or operate a motor vehicle registered in Virginia during the last year?

Yes

Did you own a vehicle registered in another state?

Yes

Did NOT own or operate a motor vehicle.

True

False

Are you or your spouse an active duty member of the U.S. Armed Forces?

Yes

Are you or your parent a Veteran of the Armed Forces?

Yes

Who is a member?

Self

Spouse

Are Virginia income taxes paid on all military income?

Yes

Where is the military member stationed?

Submit a copy of the military ID card showing your relationship to the military member.

Submit a copy of the military orders assigning you, or your spouse, to this station.

If you are a veteran please submit a copy of your DD214.

Section B-Parent, Legal Guardian, or Spouse

The person that claimed the applicant as a dependent or has provided more than half of the applicants financial support.

Parent

Legal Guardian

Spouse

Did you reside with this parent, spouse, or guardian?

Yes

This section must be completed by the applicant’s parent, legal guardian, or spouse, who during the last tax year claimed the applicant as a dependent, or who, for the twelve months immediately preceding the first day of classes, has provided more than half of the applicant’s financial support.

Name of Person Indicated Above

Please indicate your citizenship status.

Please specify your visa type.

Visa Expiration Date

How long has the parent/guardian/spouse lived in the state of Virginia?

less than a year

one year

less than two years

two years or more

Where have you, the parent/guardian/spouse, lived in the sense of physical presence during the last two years. Please list current address first.

Country

Street

City

Region

Postal Code

From what date:

To what date:

Still residing at this location.

Yes

Did you reside at this address for two years or more?

yes

You have indicated that you lived at the previous address less than two years. Please indicate your address before this time.

Country

Street

City

Region

Postal Code

Lived at this address from:

Moved to another location on:

Are you a resident of Virginia?

Yes

Are you a US Armed Services active duty or veteran?

Yes

Please provide employment information for at least one year prior to the date for which in state tuition rates are sought.

Name of Employer:

Country

City

Region

Postal Code

Were you employed here for at least one year?

yes

You have indicated you were employed here for less than one year, please provide your previous employer below.

Name of Employer:

Country

City

Region

Postal Code

In the last tax year, did you file a state return to any state other than Virginia?

Yes

If yes, please explain.

Will you have claimed the applicant as a dependent on your federal and Virginia income tax return for the tax year prior to the term in which the applicant will enroll?

Yes

If no, please explain.

Will you have provided more than half of the applicant’s financial support for at least twelve months prior to the term in which the applicant will enroll?

Yes

If no, please explain.

For at least one year immediately prior to the term in which the applicant is claiming in-state status, will you have filed a tax return or paid income taxes to Virginia on all earned income?

Yes

If no, please explain.

Are you a registered voter in Virginia?

Yes

Date of Original registration:

If not Virginia, please indicate the state, if applicable, where you are registered to vote in another state.

Does the parent/legal guardian/spouse own a car?

Yes

State of Registration

Date of registration.

Does the parent/guardian/spouse own real estate?

Yes

State where property taxes were mostly recently paid.

Real Estate Title Date.

Is there anything else we should know before making a decision? If so, please let us know here.

Parent/Spouse Signature

I certify the information I have provided is true. Please type your name in the box in place of your signature.

Please type your name in the box in place of your signature.

Date

Applicant Signature

I certify that all information submitted in the admission process - including this application and any other supporting materials - is my own work, factually true, and honestly presented, and that these documents will become the property of the institution to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be false.
I agree to notify the institutions to which I am applying immediately should there be any change to the information requested in this application, including disciplinary history.
I understand that once my application has been submitted it may not be altered in any way; I will need to contact the institution directly if I wish to provide additional information.
I acknowledge that I have reviewed the application instructions for the college receiving this application. I understand that all offers of admission are conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.

I certify that all information submitted in the admission process - including this application and any other supporting materials - is my own work, factually true, and honestly presented, and that these documents will become the property of the institution to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be false.
I agree to notify the institutions to which I am applying immediately should there be any change to the information requested in this application, including disciplinary history.
I understand that once my application has been submitted it may not be altered in any way; I will need to contact the institution directly if I wish to provide additional information.
I acknowledge that I have reviewed the application instructions for the college receiving this application. I understand that all offers of admission are conditional, pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.

I Agree

I Disagree

In place of your signature, please type your full legal name:

Date