Mercer University

MACON I ATLANTA I SAVANNAH

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Application for Admission

First Name, Middle Initial

Last Name

Previous Last Names

Social Security Number

Birthdate (mm-dd-yyyy)

Gender

Male Female

Address

Address (line 2)

City

State

Zip code

E-mail Address

Home Phone Number

Cell Phone Number

(Optional; Used for statistical reporting purposes only)
Are you Hispanic or Latino?	Yes, I am of Hispanic/Latino Origin.	No, I am not of Hispanic/Latino Origin
Are you Hispanic or Latino?	Includes all persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.	No, I am not of Hispanic/Latino Origin
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:	White	Asian
	Black or African American	No Response
	American Indian/Alaska Native
	Native Hawaiian or other Pacific Islander

Religious Preference:	Baptist	Islam/Muslim
	Methodist	Evangelical
	Presbyterian	Hindu
	Episcopalian	Buddist
	Catholic	No Preference
	Lutheran	Other
	Jewish	No Response

Citizenship Type

U.S. Citizen
Permanent Resident
Alien ID:

Non-Resident Alien;
Country of Citizenship:

Location that you wish to attend

Please select a program

Desired Year of Entrance

Desired Semester of Entrance

Semester:
Fall I (August)
Spring I (January)
Summer I (May)

Fall II (October)
Spring II (March)
Summer II (July)

Application Type

I am an incoming freshman.

I am a transfer student.

I am a graduate/professional student.

I have attended Mercer before and wish to be readmitted.

High School Graduates
High School Name:
City:
State
Zip:
County:
Curriculum:	College Preparatory Track General Track Vocational Track
High School GPA
ACT Composite Score
SAT Math + Verbal Total
Date of high school graduation (or expected date):
GED Recipients
State of GED examination:
Date of receipt of GED:

College History

List ALL colleges, universities, and technical schools attended (begin with the most recent):

Institution	Location (City, State)	Dates of Attendance	Degree Received
		TO
		TO
		TO
		TO
		TO

(It is your responsibility to see than an official college transcript is sent to the Office of Admission form EACH college or university attended. An official high school or GED transcript is also required if you have earned less than 45 quarter hours or 30 semester hours of college credit.)

If currently enrolled in college, indicate the last expected date of enrollment:

Which campus or center?
Dates of previous enrollment:	From: To:
Have you attended another college, university, or technical school since leaving Mercer University?	Yes No
If yes, give name of institution and dates of attendance. Institution:
From:	To:
(Please send an official transcript to the Office of Admissions)

College History

List ALL colleges, universities, and technical schools attended (begin with the most recent):

Institution	Location (City, State)	Dates of Attendance	Degree Received
		TO
		TO
		TO
		TO
		TO

If currently enrolled in college, indicate the last expected date of enrollment:

Test Scores
Please see degree requirements for the program to which you are applying.

Submitting

Composite Score

Employer Information

Name of Employer:

Position:

Address:

City:

Zip:

Phone:

Does your employer provide financial assistance?

Yes
No

Are you a member or veteran of the U.S. Armed Forces?

Yes
No

If yes, give branch and dates of military service:

(Most veterans may receive credit for military service experience by filing a copy of their DD Form 214; those on active duty may receive credit by filing a copy of their DD Form 295.)

Have you ever been placed on probation at any college, university, or technical school?

Yes
No

If yes, what quarter/semester and year were you placed on probation?

At which college?

Have you ever been suspended, excluded or dismissed from any college, university, or technical school?

Yes
No

If yes, please indicate the name of the school dates, and explain the situation:

Please give the source of your interest in Mercer University:

Alumni
Student
Friend
Center Coordinator
Instructor
Brochure
Flyer
Presentation

Educational Fair
Company Visit
Newspaper Ad
TV Commercial
Radio
Internet
Other

If you would like to recommend a friend to Mercer University, please complete the information below:

Name:

Address:

Address (line 2):

City:

Zip:

Phone Number:

Fee-Waiver Code:

I certify that the information provided in this application is true and correct to the best of my knowledge. I agree that, if accepted, I will abide by all the rules, procedures, and policies of the University, now and hereafter adopted, as set forth in the University Bulletin, the Code of Conduct for Students, and the Honor System. I understand that falsification or misrepresentation of information in any admission document is grounds for denial of admission or may result in dismissal from Mercer University.

Atlanta Emergency Hotline Number: (678) 547-6111
Macon Emergency Hotline Number: (478) 301-5335