Application for Admission AFTER SUBMITTING YOUR ONLINE APPLICATION, IF YOU DO NOT RECEIVE CONFIRMATION THAT YOUR APPLICATION WAS SUBMITTED SUCCESSFULLY, PLEASE CALL 870-722-8524. THANK YOU! Social Security Number*Name* First Middle/Maiden Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County*Home Phone NumberCell Phone NumberDate of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of Birth (City, State)*Email* Enrolling for* Fall Spring Summer Enrollment Year*Which UAHT campus do you plan to attend?* Hope Texarkana Both Resident StatusHave You resided in Arkansas for the last 6 months?*YesNoHave You resided in Hempstead County for the last 90 days?*YesNoAre you a United States Citizen?*YesNoAre you a permanent U.S. Resident?YesNoAre you a current/former member of the US Armed Forces?YesNoAre you a current/former member of the National Guard?YesNoAre you a current/former member of the Reserves?YesNoEthnic 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 SexMaleFemaleAdmission 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 YearHigh School AttendedGED YearState Issuing GEDTransfer from Other Arkansas College/UniversityTransfer from Out-of-State College/UniversityList all colleges and universities previously attended in order of attendanceCollege/UniversityDate of AttendanceCredit Hours Earned Have you attended UAHT before?*YesNoWhat year(s)?Student LevelFirst Year (0-29 hours)Second Year (30-64 hours)College GraduateOtherDegree SoughtAssociate of Arts - Transfer for All MajorsAssociate of Arts - Criminal Justice FocusAssociate of Arts - Human Services FocusAssociate of Arts - UAMS TrackAssociate of Science in BusinessAssociate of Applied Science in Business AdminAssociate of Applied Science in Crime SceneAssociate of Applied Science in Early Childhood EdAssociate of Applied Science in Funeral Service EdAssociate of Applied Science in General TechnologyAssociate of Applied Science in Information TechnologyAssociate of Applied Science in Law Enforcement AdminAssociate of Applied Science in Medical Office ManagementAssociate of Applied Science in Nursing - (ARNEC)Associate of Applied Science in ParamedicAssociate of Applied Science in Power Plant TechnologyAssociate of Applied Science in Supply Chain ManagementAssociate of General Studies (not transferrable)Associate of Applied Science, General TechnologyTo select multiple hold down Ctrl key and select with mouseOR Technical Certificate SoughtAccountingBusiness AdministrationCommercial and Residential Equipment Maintenance & RepairCrime Scene InvestigationDiesel Technology - Basic and AdvancedFuneral DirectingHealth ProfessionsHeating, Ventilation & Air ConditioningIndustrial ElectricityIndustrial Maint. Technology - Machining or Multi-CraftInformation TechnologyLaw Enforcement AdministrationMedical Office ManagementParamedicPower Plant TechnologyPractical NursingSupply Chain ManagementWelding TechnologyOR Certificate of Proficiency SoughtBuilding MaintenanceChild Development AssociateCertified Nursing AssistantCrime Scene InvestigationDiesel Technology - Brakes/Power TrainsDiesel Technology - Electrical SystemsDiesel Technology - Chassis SystemsDiesel Technology - Engine SystemsEmergency Medical Technician - BasicHeating, Ventilation, and Air ConditioningIndustrial Technology - MechanicalInformation TechnologyLaw Enforcement AdministrationMajor AppliancesMedical Office ManagementPower Plant OperationsPower Plant TechnologySupply Chain ManagementWelding Technology - BasicWelding Technology - Construction WeldingIf your degree intent is other than listed above, please specifyWhen you complete your degree at UAHT, do you plan to transfer to another institution?YesNoIf yes, which institution do you plan on transferring to?Did either of your parents complete a four-year college degree?*MotherFatherBothNeitherAre you a convicted sex offender?*YesNoIndicate 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.