Honors Program Member Application Form

Division of Academic Affairs Velma Fudge Grant Honors Program

Student Information

First Name*

Last Name*

RAM ID

Cell Phone Number*

ASU E-mail Address*

Alternative E-mail Address

ASU Residence Hall Assignment

Home Address*

Date of Birth*

T-Shirt Size*

Select

Emergency Contact Information

Full Name

Contact Number

Education Information

Current Major

Select

Desired Major

Select or enter value

Minor

Select

Were you dual enrolled or will you have any transfer credits?

Yes

What college or university will your transfer credit come from?

Are you a First Generation College Student?*

Yes

Are you a citizen or permanent resident?*

Yes - Permanent Resident

Yes - U.S. citizen

No - Neither

Are you a PELL Grant recipient?*

Yes

Do you plan to attend Graduate school?*

Yes

Do you plan to attend Medical school?*

Yes

Do you plan to attend Law school?*

Yes

Are you a member of an ASU sports team or program?*

Yes

If yes, which team or program?

Are you planning to join an ASU sports team or program?*

Yes

If yes, which team or program?

Please list your career goals:*

During your matriculation at Albany State University, have you conducted research with a professor at ASU or another institution?

Have you participated in a summer research program or internship?

By signing below I hereby agree to the following:

• I must maintain a 3.5 or better cumulative grade point average. If my cumulative academic average falls below 3.5 during any academic semester, my eligibility to participate in the program will be evaluated and appropriate action taken. If my cumulative grade point average drops below a 3.0 I will be automatically dismissed from the program. • I must be a full-time student, each semester I am enrolled (exception-Summer Semester). • I must adhere to the rules, regulations and guidelines listed in the V.F. Grant Honors Program Handbook. • I must participate in the Honors Program Curriculum by completing a minimum of 16 honors course credit hours. • I must participate in the Honors Council and be an active member until I graduate and attend scheduled meetings and events. • I understand I MUST participate in research through the Center for Undergraduate Research or through my department at least one semester. (Mandatory for the first semester of enrollment in the program.)

Student Signature:*

Date Signed:*

Send me a copy of my responses

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