New THSU Application for Admission

Please fill out all required fields. If a field does not apply to you, please type in "N/A"

Application Date

Campus

Enroll In

Program

First Name

Middle Name

Last Name

Picture File

Gender

Ethnicity

Home Phone

Cell Phone

Email

Street

City

State/Province

Zip/Postcode

Country

Birth Date

Social Security No

Driver License No.

Are you a U.S. Citizen

Yes No Not Selected

If no, list visa or residency status:

Country of Birth

Passport Number

Education

Please list ALL undergraduate, graduate, and doctoral work.

1. School or college

City & state

Degrees &ampampampamp; major

2. School or college

City & state

Degrees &ampampampamp; major

3. School or college

City & state

Degrees &ampampampamp; major

List any special honors or recognitions recieved:

Are you in the first generation of your family to attend college?

Yes No Not Selected

Referral Source

How did you first learn about THSU?

Tuition Payment Information

1. How will you pay tuition?

Full Payment

Installment Payments

Financial Aid

Veteran Benefits

Other

Emergency Contact

Contact Name

Relationship

Home Phone

Cell Phone

Street

City

State

Signature

Date

I attest that, to the best of my knowledge, all statements made in this application are complete and true. I understand that any falsification as well as failure to submit all required documents may result in denial of this application, or my subsequent dismissal from Texas Health and Science University. I also understand that by typing my name in the above signature box, I am officially signing my application for admission.