Texas Health and Science University
4005 Manchaca Rd Austin, TX 78704
512-444-8082

New Student Application
General Information

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

Application Date  (Required)
Campus
First Name
Middle Name
Last Name
Social Security No  (Required)
Street
City
State/Province
Zip/Postcode
Country
Home Phone
Cell Phone
Work Phone  (Required)
Email
Birth Date
Gender Male Female
Are you a U.S. CitizenYes    No    Not Selected  (Required)
If no, list visa or residency status:  (Required)
Country of Birth  (Required)
If your native language is not English, note TOEFL score:  (Required)
If foreign applicant, are you applying for a student visa?  (Required)
Date TOEFL Taken:  (Required)
Driver License No.  (Required)
State  (Required)
Expiration Date:  (Required)
Picture File
Program (Required)
Enroll in


Emergency Contact Information

Contact Name
Relationship
Street  (Required)
City  (Required)
State  (Required)
Zip  (Required)
Home Phone
Work Phone
Cell Phone


International Students

1. Estimate of available personal funds  (Required)
Monthly Amount  (Required)
2. Estimate of funds from parent/family  (Required)
Monthly Amount  (Required)
3. Other sources of support(specify)  (Required)
Monthly Amount  (Required)
Estimate of total monthly support  (Required)
Total Annual Amount  (Required)

Education

1. School or college  (Required)
City & state  (Required)
Dates attended  (Required)
Degrees & major  (Required)
2. School or college
City & state
Dates attended
Degrees & major
3. School or college
City & state
Dates attended
Degrees & major
4. School or college
City & state
Dates attended
Degrees & major
5. School or college
City & state
Dates attended
Degrees & major
List any special honors or recognitions recieved:

Work & Professional Experience

1. Dates
Job title
Name of organization & location
Nature of work
2. Dates
Job title
Name of organization & location
Nature of work
3. Dates
Job title
Name of organization & location
Nature of work
4. Dates
Job title
Name of organization & location
Nature of work
5. Dates
Job title
Name of organization & location
Nature of work
Have you ever had a professional license revoked or suspended?Yes    No    Not Selected
If yes explain:

Referral Source

How did you first learn about THSU?  (Required)

Tuition Payment Information

1. How will you pay tuition?Full Payment
Installment Payments
Financial Aid
Veteran Benefits
Other
  (Required)
2. Have you ever defaulted on a student loan or declared bankruptcy?Yes    No    Not Selected  (Required)
If yes explain:  (Required)

Relatives

1. Name  (Required)
Relation  (Required)
Address  (Required)
Phone  (Required)
2. Name  (Required)
Relation  (Required)
Address  (Required)
Phone  (Required)
3. Name  (Required)
Relation  (Required)
Address  (Required)
Phone  (Required)

References

1. Name  (Required)
Position  (Required)
Address  (Required)
Phone  (Required)
2. Name  (Required)
Position  (Required)
Address  (Required)
Phone  (Required)
3. Name  (Required)
Position  (Required)
Address  (Required)
Phone  (Required)

Application Checklist

Application and evaluation feeYes    No    Not Selected
Official transcriptsYes    No    Not Selected
Copies of licenses or certificates in the healing arts (if any).Yes    No    Not Selected
Two (2) face photographs of passport quality and size.Yes    No    Not Selected
A letter of interest explaining your reasons for wanting to attend THSU.Yes    No    Not Selected
Two (2) letters of recommendation.Yes    No    Not Selected
A photocopy of your driver's license or passport.Yes    No    Not Selected

Signature

Signature  (Required)
Date  (Required)


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.


Enter the above code
 Required