UMS | Application

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Identification

Name:
ID (PS)#:

Permanenent Address

Street Address:
City:
State/Province
Zip Code/Mailing Code
Country
Permanent Phone Number

Local Address

Street Address:
City:
State
Zip Code
Local Phone Number
Cell Phone Number
Email

Student Information

Goals:

Major:

Minor:

Career Goal:

Expected Fresno State:

Entry Date?

Graduation Date?

Education:

Community College:

High School

Family Information

Parental Occupations

Father's Name

Is your Father a farmworker?

Yes

Unspecified

Mother's Name

Is your Mother a farmworker?

Yes

Unspecified

Family Size:

Family Income?

$0-29,600			$29,601-32,700
$32,701-37,600			$37,601-42,200
$42,201-47,400			$47,401-51,200
$51,201-55,200			greater than $55,201
Unspecified

Language Spoken at Home:

Has anyone in the family graduated from College?

Yes

Unspecified

Name:
Employed By:

Miscellaneous Information

What is your college level?

NONE
Freshman
Sophmore
Junior
Senior
Unspecfied

Do you qualify for financial aid?

Yes

Unspecified

Do you own a computer?

Yes

Unspecified

Do you have Internet access at home?

Yes

Unspecified

Are you a transfer student?

Yes

Unspecified

Were you a member of the Migrant Education Program K-12?

Yes

Unspecified

Were you a member of CAMP?

Yes

Unspecified

Were you a member of the EOP?

Yes

Unspecified

Were you a member of the HCOP?

Yes

Unspecified

Were you a member of the MEP?

Yes

Unspecified

I understand that it may be necessary for UMS to access my university confidential records. I grant my permission for UMS to access my confidential records.

Signature:

Date: