Texas Semester Application

The TEXAS SEMESTER Application * Required
	First Name: *
	Middle Name:
	Last Name:*
	Date of Birth:
	Social Security No. (optional)
	Sex:	Male Female

	Street or Box No.
	City:
	State:
	Zip Code:
	Valid Until:
	Telephone:
	Email:*

	Permanent Address (if different from above)
	Street or Box No.
	City:
	State:
	Valid Until:
	Telephone:
	Email:

	Home College or University:
	Present Academic Standing:	Freshman Sophomore Junior Senior Other
	Explain:
	Cumulative G.P.A.:
	Academic Major(s):
	Academic Minor(s)
	Are you/Have you ever been on academic probation:	Yes No
	Explain:
	Are you/Have you ever been on disciplinary probation?	Yes No
	Explain:
	Learned of The Texas Semester program from: