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General Information
Admission Date:	Fall Spring SummerYear:
Admission Status:	Freshman Transfer Special
Attendance Plans:	Full Time Part Time
Full Name:
Home Address (Permanent Mailing Address):
Street:
City
State:
Zip:
Telephone No.
County:
Religious Affiliation (Denomination):
Gender:	Male Female
What is your intended field of study? List Major:

Family History
Father
Father's Name:	Status:  Living Deceased Guardian
Highest Level of Education Completed (Number of Years):	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Alumnus:	Yes No Telephone No. (Work):
Mother
Mother's Name:	Status: Living Deceased Guardian
Highest Level of Education Completed (Number of Years):	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Alumnus:	Yes No Telephone No. (Work):
Emergency Contact Information
Emergency Contact Name:	Relationship to Applicant:
Emergency Contact Telephone No.
If your parents are divorced or separated, with whom do you live?	Not Applicable Father Mother

List all schools and colleges you have attended, in chronological order beginning with the present school.

School Data
School 1:
Name of School:
Attendance Dates (From-To)
Diploma, Degree or Type of Discharge:
School 2
Name of School:
Attendance Dates (From-To)
Diploma, Degree or Type of Discharge:
School 3
Name of School:
Attendance Dates (From-To)
Diploma, Degree or Type of Discharge:

Please indicate below those organizations in which you have participated and/or won particular honors or recognition. (student government, clubs, choir, band, athletics, etc.)

List any awards and citations and the date in which they were earned during high school.

College Entrance Examination (SAT/ACT)
SAT	Verbal:	Math:	Total:	Date Taken:
First time taken:
Second time taken:
ACT	Composite Score:	Date Taken:
First time taken:
Second time taken:

If you are a freshman applicant, list any courses you have taken or are taking at college.

Course 1
Course Name:		College/University:
Grade Received:		Dates Attended:
Course 2
Course Name:		College/University:
Grade Received:		Dates Attended:
Course 3
Course Name:		College/University:
Grade Received:		Dates Attended:

Do you want to be considered for a competitive academic scholarship? (must apply by January 15):	Yes No
Would you like your application/documents forwarded to the Alice Carson Tisdale Honors College for nomination?	Yes No
Do you plan to live on campus?	Yes No

 Please answer all of the following questions:

a. Have you ever been convicted of a criminal offense?	Yes No
b. Have you ever been placed on probation, suspended or expelled from any educational institution?	Yes No
c. Has there been any gap in your educational experience longer than a summer?	Yes No
d. If the answer to any of the above questions is yes, please explain below.

If you are not a U.S. citizen, state the type of visa you hold:
If English is not your primary language, please specify your first language:

Write a 500 word essay that discusses your reasons for applying to Claflin University and your future plans. Mail in the essay, along with your signature to the address below. Although your application is submitted online, it is not complete and will not be processed until we receive your signature and/or your parent's signature (if you are a dependent) along with your essay.

Claflin University
Office of Admissions
400 Magnolia Avenue, N.E.
Orangeburg, SC 29115-9970