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SAU Tech Application for Admission

It is recommended that you print this form in order to keep a copy for your files.
You can also download the Printable Version and send it in via fax or regular mail.

Southern Arkansas University Tech
Office of Admissions
P.O. Box 3499
Camden, AR 71711
Voice: (870) 574-4558
Fax: (870) 574-4478

Instructions - Complete all fields below. Use the Tab key on your keyboard to move between fields. If some of the fields do not apply to you, do not enter any data.

Identification Information:


*
Social Security Number
(Example: 123-45-6789)
*If you do not have a social security number, please enter 'N/A'

*
First Name

Middle Name
*
Last Name

Maiden Name

Suffix

*
Gender
*
Marital Status
*
Children at home?

*
Address

*
City

State

Province/State
(If Outside United States)
*
Zip Code


County/Parish

Country

*
Home Phone
(Example: 918-555-1234)

Work Phone
(Example: 918-555-1234)

Cell Phone
(Example: 918-555-1234)

Accept Text Messages


E-mail Address


Do you consider yourself a displaced homemaker?
(A displaced homemaker is someone who is unemployed or underemployed and is experiencing difficulty in obtaining or upgrading employment.) *


Is English the language normally spoken at home? *


Did either of your parent's complete a four year degree? *


Do you consider yourself to be Hispanic/Latino: *

Race:
(For Federal/State reporting purposes only - The information below will be used in a nondiscriminatory manner consistent with civil rights laws.)






Date of Birth *
(Ex: MM/DD/YYYY)

Citizenship Information:



Are you a US citizen? *

If not a US Citizen:

If not US citizen,
country where you hold citizenship

If not a US Citizen,
Type of Visa


If resident alien,
Alien Registration Number

If resident alien,
Alien Registration Number Date of Issuance

*
City of Birth

State/Province of Birth

Country of Birth

Province/State of Birth
(If Outside United States)


Resident of Arkansas?

If not, list state or country of residence

How long will Arkansas have been your legal residence immediately
prior to to attending SAU Tech?
If not Arkansas resident, leave blank

Selective Service Registration Status:


State of Arkansas - Statement of Selective Service Status in Compliance with ACT 228 of the 1997 Acts of the Arkansas General Assembly.
I understand that to be eligible for admission to Southern Arkansas University Tech, I must register, or be exempt from registration, with the Selective Service System in accordance with the Military Selective Service Act, 50 U.S.C. Appx 451 et seq., as specified in Act 228 of the 1997 Acts of the Arkansas General Assembly. I therefore swear or affirm under penalty of perjury that I have registered with the Selective Service System, or I am exempted from such registration because of the following provision(s) of the Military Selective Service Act or Act 228 of the 1997 Acts of the Arkansas General Assembly.


Selective Service Status *

Emergency Contact Information:



Emergency Contact

Name


Home Phone

Work Phone

Cell Phone


Address


City

State

Zip


E-mail Address

Educational Information:



Seeking admission as *

Reason for attending SAU Tech *

Term of planned enrollment *


Is it your intention to obtain a two (2) year Associate Degree?
If yes, choose an option in the Associate Degree box below

Is it your intention to obtain a one (1) year Technical Certificate?
If yes, choose an option in the Technical Certificate box below

Is it your intention to obtain a Certificate of Proficiency? (Less than one (1) year)
If yes, choose an option in the Certificate of Proficiency box below

Associate Degrees (2 year program)
(Hold the "Ctrl" key to make multiple selections)

*** = Requires Pre-Approval prior to being admitted.

Technical Certificates (1 year program)

*** = Requires Pre-Approval prior to being admitted.
Certificates of Proficiency (Less than 1 Year)

*** = Requires Pre-Approval prior to being admitted.

(Non-degree seeking students are NOT eligible for Federal/State Financial Aid.)

Educational Background:



High School Status *

Graduation Date*

School Attended
(If GED: State Issuing GED) *
List all colleges, universities, or other post-secondary institutions attended since leaving high school:

College/University
Dates of Attendance
Credit Hours Earned




Disciplinary Information:


Have you ever been convicted, pleaded guilty, pleaded no contest, or are you presently charged by indictment or information with a crime (a felony) which might be punishable by incarceration? *
Have you ever been committed to a correctional or training institution *

*** If the answer to either question is 'Yes', send details in an email to bellis@sautech.edu; include date, name of court, nature of offense, status of charge, penalty imposed, if any, or other disposition.

By submitting this application, you affirm that you have read and understood all the information on this application and the information you have provided is factually correct and honestly prepared. Any misrepresentation of facts could be cause for refusal of admission or suspension from the college.

When you have completed the Online Application for Admission, click the "Submit" button ONE TIME ONLY.



Please send questions or comments to Admissions