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Admission Application


Please note: Some fields will not accept punctuation, such as commas. All required fields must be completed. These are marked with a red (*) asterisk.

Name:

   

*Last:

 

*First:

 

*Middle   
  Initial:

 

Maiden Name:

 

Preferred Name:

 

*Social
  Security
  Number:

(ex. 999999999)  

Mailing Address:

*Street/P.O.
  Box:

 

*City :

 

*County:

 

*State:

*Zip:

E-Mail:

 

Telephone:

(ex. 999-999-9999)  

Work Number:

(ex. 999-999-9999)  

Cell Number:

(ex. 999-999-9999)  

If you have lived at the above address for less than six months,
provide previous address:

Street/P.O. Box:

 

City:

 

County:

 

State:

Zip:

*Date of
  Birth: 

(mm/dd/yyyy)  

*Place of
  Birth:

 

 

 

 

Are you or your parents currently on active duty in the military service? 

*Name of Father, Mother, Legal Guardian, or Spouse:                                                 

*Relationship:

 

Street/P.O. Address:

 

City:

 

State:

Zip: 

Telephone:

(ex. 999-999-9999)  


I am applying as:

     

I am a :

 
     

Citizen of: 

 

Visa Type:

 

Other

 
     

*Applying
  for:

Year:  (ex. 07, 08, 09, 10) Term:

I plan to:

 
     

For Statistical Purposes only (Voluntary Optional Information) :

     

Gender:

 
    Do you consider yourself to be Hispanic/Latino?
    Yes No

Race/Ethnicity (select one or more):

Asian Yes No

Black  or African American Yes No

Native Hawaiian or Pacific Islander Yes No

American Indian or Alaska Native YesNo
  White  Yes No  
   

At least one of my parents earned a college degree:

   

Academic Background

 

*High
 School:

 

*City and 
 State:

 

*Graduation
  OR
  GED Date:

 (ex. yyyy)

 


Have you ever attended UAM?

If yes, When?

Have you earned a degree from UAM?

If yes, Which Degree?

 

 

 

List in chronological order, all the colleges and universities you have attended since high school, including UAM.

Institution/College

State/Country

Date(s) Attended(ex. 06-07)

Certificate Hours or Degree Earned

   

   

   

   

Are you currently enrolled at another college?

If yes, which one?

Do you plan to teach?

Are you currently teaching?

What grade level?

(K-12)

Seeking teacher Licensure?

 If yes, what subject?

     

*Please indicate your planned field of study (select one only) or check:  I have not decided

     

School of Agriculture

 

Agriculture (B.S.)

 

Specify:   

Agriculture Business
    Animal Science
    General Agriculture
    Plant and Soil Science

School of Arts and Humanities

Art (B.A.)

English (B.A.)

 

Specify:

Creative Writing Concentration
    Literature Concentration
    Professional Writing Concentration

Modern Languages (B.A.)

Speech Communication (B.A.)

 

Music (B.A.)

 

Specify:

Instrumental*
    Piano*
    Voice*
    Music Theatre

Music Education (B.M.E)

    Voice
    Piano
 

 

Instrumental
*Option available for both music and music education.

School of Business

Accounting (B.B.A.) 

 

Business Administration (B.B.A.)

 

Specify: 

Business Administration
    Entrepreneurship
    Finance
    Management
    Marketing

School of Computer Information Systems

Computer Information Systems (B.S.)

Advanced Certification (B.A. / B.S. required)

School of Education
Undergraduate Program

P-4 Early Childhood (B.A.)

Middle Childhood Education 4-8 (B.A.)

P-12 Licensure Areas

 

Music (B.A.)

 

Specify:

Vocal
    Instrumental
    Piano

Health and Physical Education (B.S.)

Non-Licensure Areas

Health and Physical Education (B.A./B.S.)

Health & Physical Education - Exercise Science (B.S.)

Graduate Programs

Master of Arts in Teaching (M.A.T.) (Secondary content licensure areas,
P-12 licensure in art, physical education, music, foreign language, middle childhood)

Master of Education (M. Ed.)

Master of Education Ed. Leadership

Non-Degree Option

Educational Leadership

 School of Forest Resources

Forestry (B.S.)

Spatial Information Systems (B.S.)

Wildlife Management (B.S.)

Land Surveying Technology (A.S.)

Master of Science (Forest Resources)

School of Mathematical and Natural Sciences

Biology or Organismal Biology (B.S.)

Chemistry (B.S.)

     Biochemistry

Mathematics (B.S.)

Natural Science (B.S.)

School of Nursing

    Nursing (B.S.N.)

Nursing, RN (B.S.N.) 

Nursing, LPN to RN (A.A.S.N.)

School of Social and Behavioral Sciences

Criminal Justice (B.S.)

History (B.A.)

History and Social Studies (B.A.)

Political Science (B.A.)

Psychology (B.S.)

Social Work (B.S.W.)

Crime Scene Investigation (A.A.S.)

Law Enforcement Administration (A.A.S.)

Pre-Professional Studies

Allied Health 

 

 

( Specify Field)

 

Pre-Dentistry

 

Pre-Engineering

 

Pre-Law

 

Pre-Medicine

 

Pre-Pharmacy

 

Pre-Veterinary Medicine

 

Division of General Studies

  Associate of Applied Science
 

Specify:

Agriculture Production Mgmt
    General Technology
    Industrial Technology

Associate of Arts

Bachelor of Applied Science

Bachelor of General Studies


Other

 

 

Specify:

 

Technical Certificates*

Administrative Office Technology

Agriculture Technology

Automotive Service Technology

Computer Maintenance/Networking

Crime Scene Investigation***

Early Childhood Education

Electromechanical Maintenance

Electromechanical Tech. / Industrial Controls

Electromechanical Tech. / Instrumentation

Emergency Medical Technology

Heavy Equipment Operation

Construction

 

Timber Production

Hospitality Services

Law Enforcement Administration***

Practical Nursing

Welding Technology

Certificates of Proficiency*

Child Development Associate (CDA)

Cisco Network Associate

Computer Repair and Networking

Crime Scene Investigation ***

 

Emergency Medical Technology
Technician Basic

 

Intermediate

Healthcare Office Skills

Hospitality Skills

Industrial Equipment Repair

Law Enforcement Administration ***

Nursing Assistant

Office Support

Welding

Other

 

Specify:

*Available through the Crossett and McGehee campuses only. ***Program requires prior completion of police academy curriculum.


(The University releases information on the quality of its teacher preparation program to the requirements of Section 207 of Title II of the Higher Education Act as amended in 1998. Official Title II data is published in appropriate University publications. Inquiries concerning Title II data should be directed to the Dean, School of Education, (870) 460-1062)


**Proof of immunization against measles, rubella and mumps is required of applicants. Proof should be submitted as two MMR injections. Tuberculin skin testing required on foreign-born applicants. **


Military Selective Service Act

Arkansas Act 228 of 1997 requires compliance with the Military Selective Service Act as a condition of enrollment in a public institution of higher education. No person who is required to register with the selective service system shall be eligible for admission to any public institution of higher education unless the person has signed a statement of selective service status.


*I swear under penalty of perjury that:

I have registered with the selective service system in accordance with the Military Selective Service Act.

I am not required to register with the selective service system because:

 

 I am under 18
 

I am in the armed forces of the United States on active duty, other than in a reserve or national guard unit.
 

I am an alien lawfully admitted to the United States as a non-immigrant under Section 101 (A)(15) of the Immigration and Nationality Act and am not required to register for as long as I maintain a lawful, non-immigrant status in the United States.
 

I am a permanent resident of the trust territory of the Pacific Islands or the Northern Mariana Islands.
 

I am female.
 

 I am excused from registration for another reason provided by federal law and that reason is:
   

*Failure to check below will make this application invalid.

I certify that none of the information requested on this form is false or has been withheld. I understand that withholding information requested or giving false information may make me ineligible for admission and enrollment. I also understand that I will not be officially admitted until I have submitted credentials and met stipulated admission criteria. If I am a transfer student, I am verifying that I am admissible to the institution from which I am transferring.

I agree to these terms
I do not agree to these terms

STUDENTS WHO FALSIFY ADMISSION INFORMATION OR CREDENTIALS MAY BE DISMISSED FROM THE UNIVERSITY

The University of Arkansas at Monticello is firmly committed to complying with all applicable federal, state and local laws, and regulations, which provide educational and employment opportunities to all persons, regardless of their economic or social status. The University will not discriminate on the basis of race, color, religion, creed, gender, ethnic or national origin, disability, age, veteran status, or any legally protected class. The Office of Special Student Services has been designated to coordinate efforts to comply with all laws and regulations applicable to qualified disabled individuals, as required by Section 504 of the Rehabilitation Act of 1973. Inquiries concerning the applications of all federal laws and regulations regarding discrimination should be directed to Lathan Hairston, Babin Business Center, UAM, phone 870-460-1022.

 

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