Grambling State University
Office of Admissions
P.O. Box 864
Grambling, LA 71245
(318) 274-6183
 A Member of the University of Louisiana System
Deadline Dates: Fall - July 15th, Spring - December 1st, Summer - May 1st

DO NOT WRITE IN THIS SPACE

  _____Resident  ____Out of State
  _____State  __________Parish
  ACT________________________
 _______________________________

                    APPLICATION FOR UNDERGRADUATE ADMISSION                     

Complete, sign and return this application with a $20.00 Money Order, Cashier's Check, or Personal Check (NO CASH) non-refundable application fee ($30.00 for international students) payable to Grambling State University to: Grambling State University, Office of Admissions, P.O. Box 864, LA 71245. If you do not attend GSU for the term indicated, you must submit a new application and application fee.

DOCUMENTS SUBMITTED FOR ADMISSIONS AND RESIDENCY REQUIREMENTS BECOME THE PROPERTY OF GSU AND MAY NOT BE RETURNED.  TYPE OR PRINT IN INK AND COMPLETE ALL ITEMS. Attach Non-Refundable Application Fees $20.00, International $30.00. (NO CASH) or Fee Waivers accepted.

ENROLLMENT                                                                                                                                                           
WHEN DO YOU PLAN TO ENROLL AT GSU?                                                                 Summer High Ability Program_____
Fall_____      Spring_____     Summer_____      Summer Only_____    Distance Learning / Special Non-Degree______
PERSONAL DATA                                                                                                                                                       
NAME (Give full legal name. Do not use initials unless initials are your legal name.)
Last     First    Middle 
Former last names used on transcripts 
SOCIAL SECURITY NUMBER  --    DATE OF BIRTH
MARITAL STATUS (Optional)     GENDER:  Male    Female
RELIGIOUS PREFERENCE (Optional)     EMAIL ADDRESS:
RACE (check one)
American Indian or Alaskan Native  Asian or Pacific Islander   Black or African American
Hispanic    White or Caucasian   Other (list)
PERMANENT ADDRESS
No. & Street      City    Parish/County
State    Zip Code
HOW LONG HAVE YOU LIVED AT YOUR PRESENT ADDRESS?
Years    Months   Home Phone      VETERAN:   Yes No
MAILING ADDRESS
No. & Street City State Zip Code
WILL YOU BE AN INCOME TAX DEPENDENT OF YOUR PARENTS AND/OR GUARDIAN DURING YOUR ENROLLMENT AT GRAMBLING STATE UNIVERSITY? Yes    No *Should this status change, it is your responsibility to notify the Registrar's Office in writing.
ARE YOU A UNITED STATES CITIZEN?   Yes No
IF NO, Country of Citizenship Country of Birth
Visa Type TOEFL Score
IN CASE OF AN EMERGENCY, LIST NAME AND ADDRESS OF THE NEAREST RELATIVE. (Mother, Father, Guardian, Spouse, Brother, Sister)
Name Home Phone Relationship to you
Address   City   State    Zip
EDUCATIONAL DATA                                                                                                                                             
NAME, CITY & STATE OF LAST HIGH SCHOOL ATTENDED
Name City State
DID YOU (OR WILL YOU) GRADUATE FROM HIGH SCHOOL?
Yes (Year of Graduation) _______   No GED
DATES ATTENDED HIGH SCHOOL
From: Month Year To: Month Year
HAVE YOU TAKEN THE ACT?    Yes, test date: (month/year)   No

  • GED GRADUATES must submit proof of graduation or diploma to the Admissions Office.
  • LOUISIANA HIGH SCHOOL STUDENTS - We will request your seventh semester and final high school transcript from the Board of Regents and the Louisiana Department of Education’s Student Transcript System. It will not be necessary to have transcripts sent to Grambling State University from your high school, unless you graduated before 2004.
  • OUT-OF-STATE HIGH SCHOOL STUDENTS must have a minimum ACT composite of 17 or equivalent SAT of 810.
  • Request your high school to send an official transcript once final grades and graduation date have been posted.

HAVE YOU EVER ENROLLED AT GSU?
Yes, Dates Attended: From: Month Year To: Month Year    No

LIST NAME AND LOCATION (CITY AND STATE) OF ALL COLLEGES ATTENDED INCLUDING GSU, LISTING MOST RECENT FIRST.   ATTACH SEPARATE SHEET, IF NECESSARY Dates Attended Hours/
Credit		 Degree, Cert.
Received (If Any)		 Currently on Suspension
From (Mo/Yr) To (Mo/Yr) Y N

NOTE: OFFICIAL TRANSCRIPTS FOR ALL PREVIOUS COLLEGE WORK (EXCEPT GSU) MUST BE SUBMITTED. STUDENTS UNDER CURRENT SUSPENSION AND THOSE WHO CANNOT FURNISH OFFICIAL TRANSCRIPTS BECAUSE OF INDEBTEDNESS ARE NOT ELIGIBLE TO ENROLL AT GSU. COLLEGE TRANSFER STUDENTS must have official transcripts from EACH college or university previously attended sent to the Admissions Office, regardless if credits appear on another transcript. An official transcript is defined as one mailed directly from one institution to another. It bears the institution's seal, signature of the registrar, and the date of issuance. If you have earned less than 12 semester hours, official ACT scores must be submitted. SUMMER ONLY COLLEGE TRANSFER STUDENTS must have a letter of good standing sent from the Registrar's Office of the institution previously attended.

PROOF OF IMMUNIZATION
ALL NEW STUDENTS BORN ON OR AFTER JANUARY I, 1957, ARE REQUIRED TO SUBMIT PROOF OF IMMUNIZATION FOR MEASLES RUBELLA-MUMPS (LOUISIANA R.S. 17:170, SCHOOLS OF HIGHER LEARNING) PRIOR TO REGISTRATION. Appropriate form available in Grambling Office of Admissions or Foster-Johnson Health Center or click here (immunization form).

UNDERGRADUATE DEGREE PROGRAMS                                                                                                        

*CHECK APPROPRIATE MAJOR     

Accounting (1801)
Applied Music-Performance (3301)
Art (3101)
Art Education (2101)
Biology (3401)
Chemistry (3601)
Child Development 
      (AS-2 years) (1306)
Communication & Theatre
       Education (2114)
Computer Information Systems (1901)
Computer Science (3502)
Criminal Justice (4 years) (4101)
Criminal Justice (AS-2 years) (4102)*
Drafting Design Technology (1501)
Early Childhood Education 
      N -K & 1-3 (2121)
Economics (1401)
Electronics Engineering 
      Technology (1505)
Elementary Education, General (2120)
English Education (2105)
English (3201)
French (4001)
French Education (2111)
Health & Physical Education (2301)
History (4301)
Home Economics Education (2108)
Hotel/Restaurant Management (1304)
Industrial Arts Education (2109)
Leisure Studies (2305)
Management (1208)
Marketing (1101)
Mass Communication (3001)
Mathematics (3501)
Music Education (2112)
Nursing (Pre Nursing to BSN) (3701)
Paralegal (Certificate) (4104)
Paralegal (AA-2 years) (4103)*
Paralegal (4 years) (4105)
Physics (3901)
Political Science (4401)
Political Science (Pre-law) (4402)
Psychology, General (4503)
Public Administration (4405)
Secondary Education - Sci. & Math (2138)
Social Science Education (2115)
Social Work (5001)
Sociology (4501)
Spanish (4002)
Spec. Edu. 
      (Mild/Mod Elem Dual) (2127)
Spec. Edu. 
      (Mild/Mod Secondary) (2126)
Spec. Edu.
      (Pre Non-Cat Ear Chi Dual) (2128)
Speech Pathology (3804)
Theatre (3806)
Undecided (Basic Studies) (4899)
DISCIPLINARY:   
  1. Have you ever been convicted, pled guilty, or are you presently charged by indictment or information with a crime (a felony) which might be punishable by imprisonment in a penitentiary? Yes   No
  2. Have you ever been committed to a correctional or training institution? Yes   No. If answers to questions A or B is yes, attach a complete explanation giving date, name of court, nature of offense, status of charge, penalty imposed, if any, or disposition.
  3. Have you ever been suspended or dismissed from any college or university for scholastic or disciplinary reasons? Yes    No. If yes, give name of institution, date, and reason for this action.

RESIDENCY INFORMATION FOR TUITION PURPOSES                                                                                
MARK THE APPROPRIATE BOX
 If you have lived in Louisiana for more than two years, complete Part IV only.
If you have lived in Louisiana for less than two years, complete Part I, II or III and Part IV.
State supported colleges are required to collect documentary evidence of a student's Louisiana residency prior to enrollment. The Office of Admissions reserves the right to determine the validity of the documents submitted and to request additional information in order to comply with state residency requirements.
 PART I. CLAIM FOR RESIDENCY BASED ON SELF                                                                                        
HOW LONG HAVE YOU LIVED IN LOUISIANA?  Years    Months    
PREVIOUS STATE OR COUNTRY OF RESIDENCE
IF YOU CAME HERE WITHIN THE PAST 2 YEARS, WHY DID YOU MOVE TO LOUISIANA?
Education Employment Job Transfer Other
IF other, please explain
DRIVER'S LICENSE NUMBER STATE ISSUED EXPIRATION DATE
IS THIS A NEW OR RENEWED LICENSE? New Renewed
ADDRESS ON DRIVERS LICENSE  
HAVE YOU BEEN EMPLOYED IN LOUISIANA IN THE PAST 12 MONTHS? Yes No
EMPLOYER'S NAME    EMPLOYER'S ADDRESS
EMPLOYER'S PHONE   PERIOD OF TIME EMPLOYED FROM TO
Part-Time    Full-Time
 PART II. CLAIM FOR RESIDENCY BASED ON PARENT, SPOUSE, OR LEGAL GUARDIAN                  
NAME OF PERSON UPON WHOM CLAIM IS BASED: Last      First 
Parent   Spouse Legal Guardian    CURRENT ADDRESS 
IS PERSON A US CITIZEN?  Yes   No
HOW LONG HAVE THEY LIVED IN LOUISIANA?  Year(s)     Month(s)
IF YOU CAME HERE WITHIN THE PAST 2 YEARS, WHY DID YOU MOVE TO LOUISIANA?
Education Employment Job Transfer Other  
IF other, please explain
IF EITHER OF YOUR PARENTS (MOTHER AND FATHER ONLY or LEGAL GUARDIAN) GRADUATED FROM GRAMBLING STATE UNIVERSITY, PLEASE NOTE BELOW:


Parent's complete name while attending Grambling State University
Parent's complete name while attending Grambling State University

         
   Parent's date of birth                       Parent's Social Security Number

          
   Parent's date of birth                       Parent's Social Security Number


Parent's Graduation Date
Parent's Graduation Date

PART III. CLAIM FOR RESIDENCY BASED ON ACTIVE MILITARY ASSIGNMENT IN LA. of Self, Parent, Spouse, Legal Guardian        
NAME OF PERSON ON ACTIVE DUTY
Last     First    Middle
Self   Spouse  Parent/Legal Guardian
HOME OF RECORD (DOCUMENTS MUST BE SUBMITTED)
    
PART IV. SELECTIVE SERVICE- for U. S. males from the ages of 18 - 25                                                                                                                 
I HEARBY SWEAR OR AFFIRM UNDER PENALTY OF PERJURY, IN ACCORDANCE WITH REQUIREMENTS OF THE MILITARY SELECTIVE SERVICE ACT, AND THE REQUIREMENTS OF STATE LAW R.S. 17:3151 THE FOLLOWING: (check one)
I have registered or will register with the Selective Service (Registration with the Selective Service must be completed before university enrollment)
I am not required to register with the Selective Service for the following reason:
        (This application grants permission to GSU to register me as required by SS/LA Law if I am not properly registered, and this serves as my permission and notice.)

Disability: Students with disabilities should identify themselves with the GSU Comprehensive Counseling Center (318) 274-3288, before classes begin.

FURTHER, I CERTIFY THAT ALL INFORMATION GIVEN IS COMPLETE AND ACCURATE, AND I AGREE TO ABIDE BY ALL RULES AND REGULATIONS OF THE UNIVERSITY.  I REALIZE THAT FALSIFICATION OF ANY INFORMATION OR INTENTIONAL OMISSION OF INFORMATION MAY LEAD TO REFUSAL OF ADMISSION OR DISMISSAL FROM THE UNIVERSITY. I DO HEREBY AUTHORIZE LOUISIANA POSTSECONDARY ACCESS TO MY ACADEMIC RECORDS.

______________________________________________              _____________________________________
                              (SIGNATURE OF APPLICANT)                                                                     (DATE)

Grambling State University is an equal opportunity educational institution and will not discriminate due to race, color, creed or religion, national origin, sex, marital or parental status, age, disability, veteran status, or political belief.  This policy extends to all programs and activities supported by the University.