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Arkansas State University Three Rivers Application for Admission

To submit an application to our school, please complete the following form and select Submit Application.

= Required

Personal Information

First Name
Middle Name
Last Name
Suffix
Date of Birth
Former Last Name
Social Security Number Ex. 999999999 (no dashes, please)

Address Information

Address Type
Address Line 1
Address Line 2
Address Line 3
City
State/Province
Postal Code
County
Country

Have you lived in Arkansas consecutively for the past 6 months?

Contact Information

Please enter your personal e-mail address in the field provided below. This email address will be used for communication automated by the system such as password resets, etc...

E-mail Address

Phone Numbers (Exclude Country Code)

Phone Type	Country	Phone Number	Primary

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Demographic Information

Check all boxes below that apply.

Gender
Primary Ethnicity
Marital Status
Veteran Status
Are you a displaced Homemaker? Mark "Y" if you have never worked outside the home or have diminished marketable skills, otherwise mark "N".
Are you a first generation college student? Mark "Y" if neither of your parents have a bachelor's degree.

Ethnicity and Race Information

* This section is required.

Are you of Hispanic/Latino ethnicity or descent? Yes No

Select one or more races with which you identify yourself:
American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Citizenship Information

Primary Citizenship
Visa
Country of Birth

Government Information

International Students Only

Visa Number
Visa Country Issued
Visa Expiration Date
Passport Number
Passport Country Issued
Passport Expiration Date

Academic Information

In the "How Are You Enrolling" Section, use the chart below:

First Time entering = never attended college

High School = current high school student

Readmitted = attended previously(at least one semester lapse)

Transfer = attended another college

Unclassified = already have a degree

Semester

Programs

Program

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How Are You Enrolling?

Campus

Please Highlight the campus below you are planning to attend.

Emergency Contacts

Contacts

Add Another Contact
1. Prefix
2. First Name
3. Middle Name
4. Last Name
5. Suffix
6. Relationship
7. Phone Number

Education History

List High School of graduation or GED first, followed by ALL colleges attended, if any. If you are a current high school student, use the anticipated graduation date. If the day of Graduation Date is not known, use the 15th of the month (Ex. 05/15/2000)

Additional Institutions

Add Another Degree
1. Degree
2. Curriculum
3. HS/GED Grad Date
4. Institution Name
5. ETS Code Search
6. City
7. State
8. FICE Code
Institution Name

ETS Code

City

State

Country

School Policy

Select "I accept" to confirm that you have read and fully agree the terms and conditions set forth in our Application Policy

Policy I do not accept I accept

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Arkansas State University Three Rivers Application for Admission

Addresses

Contacts

Additional Institutions