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TE RM: 2021 Fall M AJO R: Non-degree undergraduate - Online CAMP US : Online AP P L ICATIO N ID: 3366077

SIGN OUT

Review and Certify My Application

MY INFORMATION

Legal Name Samuel Smith

Home Address 2438 Dye Street

Phoenix, AZ

United States
85048

Phone (602) 5683418

Mobile Phone (602) 5683418

Mobile SMS No

Sex Male

Military Status None of these options apply

US Citizenship I am a US citizen

Country of Birth United States

Social Security Number •••••••••

Do you qualify as a recipient or beneficiary of the No

Qualified Tuition
Reduction
(https://cfo.asu.edu/reduced-tuition) (QTR)
Program, whether as an employee of ASU or an
ASU affiliate, or
dependent or spouse of such
employee or otherwise?

PREVIOUS ASU AFFILIATION I have never been affiliated with Arizona State
University

Primary Language Spoken at Home English

Gender Male

Do you plan to use an Education Benefit or No

Scholarship through an Employer, Corporation,
Foundation or other ASU Education Partner?

Parent or Legal Guardian Rowen Smith

Parent or Legal Guardian Email rowensmith778899000@gmail.com
Parent or Legal Guardian Relation Grandparent
Parent or Legal Guardian Schooling Level High School
Parent or Legal Guardian Attended ASU No

MY SCHOOLS

Graduating School

High School Name Career Success School

Name on Transcript Samuel Smith

Location Phoenix, AZ, USA

Graduation Date May, 2020

 Past Colleges/Universities
(https://asu.edu)

ASU Admissions (https://admission.asu.edu)

College Status Never attended

MY GRADES

Self Reported No

Unweighted GPA 0.0

Class Rank/Class Size 0/0

Senior Courses

RESIDENCY

Which state do you consider to be your Arizona

permanent home?

Have you been living in Arizona continuously for Yes

the last 12 months?

When did you begin living in Arizona? April, 1998

Are you currently enrolled at another college or No

university?

Were you claimed as a dependent for income tax No

purposes by a parent or legal guardian
for 2020
or 2019?

Were you enrolled at any Arizona college or No

university in 2020
or 2019?

Do you have a current driver's license or state No

issued ID?

Do you own or operate a car, motorcycle or other No

motor vehicle?

Did you, or will you, file state taxes for 2020? No

Estimate a percentage of financial support from Employment: 50%

each of the following sources for the last

12 Parent: 0%

months.
Support includes housing, Financial Aid: 30%

transportation, tuition, books, food, Other: 20%

entertainment and
healthcare.
Indicate all that
apply and list at least 50% for the parent/legal
guardian category if your
parents/legal guardians
claim you on their taxes.

Which describes your "other" source of support Unemployment: Yes

(check all that apply)?

Are you currently employed? No

Were you employed in the last 12 months? Yes

Where was your primary work location? Arizona

In which state do your parent(s) or legal Arizona

guardian(s) currently live?

Which parent or legal guardian lives in Arizona? Both

When did your parent(s) or legal guardian(s) April, 1998

begin living in Arizona continuously?

Did or will your parent(s) or legal guardian(s) file Yes

a state income tax return for
the 2020 tax year?

In which state did, or will, your parent(s) or legal Arizona

guardian(s) file state income taxes?

Does either parent or legal guardian have a Yes

current Arizona driver license?
 Is either parent or legal guardian currently Yes
(https://asu.edu)
employed in Arizona?

Are you married?

ASU Admissions (https://admission.asu.edu) Yes

Where does your spouse live? Arizona

When did your spouse begin living in Arizona? May, 2012

Does your spouse have a valid driver's license or No

state-issued ID?

Did, or will, your spouse file a state income tax No

return for the 2020 tax
year?

Is your spouse employed? No

Is your spouse currently enrolled at ASU or any No

other college or university?

Is your spouse dependent on someone other than No

you for financial support (e.g. parents,
legal
guardians, family) or financial aid?

CHOOSE MAJOR

Primary Choice Non-degree undergraduate - Online,

Campus Online

Starting Term 2021 Fall

APPLICATION AFFIDAVIT
The information on this application is complete and correct, and I understand that any
misrepresentation or falsification is cause for canceling enrollment and/or credits earned, or other
disciplinary action. All documents submitted for admission consideration are the property of Arizona
State University and will not be returned to me, nor duplicated for me, under any circumstances.

SUBMITTING OFFICIAL TRANSCRIPTS (FOR DEGREE-SEEKING STUDENTS)

I understand that I am responsible for submitting all official transcripts from prior institutions to the
university.
However, if necessary, I grant Arizona State University permission to obtain official
transcripts on my behalf from all schools I have attended, and I authorize and direct any school
receiving such a request to provide the requested official transcript to Arizona State University.

ACADEMIC INTEGRITY
Arizona State University is committed to academic integrity in all scholarship, research and creative
endeavors. My application is an affirmation of my willingness to educate and comport myself within the
guidelines of Arizona State University's Academic Integrity and Responsible Conduct of Research
policies.

PROHIBITION AGAINST DISCRIMINATION, HARASSMENT AND RETALIATION

I understand that Title IX protects individuals from discrimination based on sex in any educational
program or activity operated by recipients
of federal financial assistance. As required by Title IX, ASU
does not discriminate on the basis of sex in the education programs or activities that we operate,
including in admission and employment. Inquiries concerning the application of Title IX may be referred
to the Title IX Coordinator or to the U.S. Department of Education, Assistant Secretary, or both. Learn
more at ACD 401: Prohibition Against Discrimination, Harassment and Retaliation.
(https://www.asu.edu/aad/manuals/acd/acd401.html)

Email: TitleIXCoordinator@asu.edu

Address: 1120 S. Cady Mall INTDSB Suite 284

Phone: 480-965-0696

asu.edu/reportit (asu.edu/reportit)

By clicking "Submit Application," you are submitting your application to Admission Services for
processing
and agreeing with the terms of the affidavit. Once submitted, you cannot change your
application online.

I , S AMU E L S MIT H , CERTIFY TH AT ALL ABOVE INFORM ATION IS CORR E CT A N D
C OMPL E T E AN D I AGREE TO THE TERMS OF THIS AFFIDAVIT.

S U BMIT MY APPLICATION
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