Temporary Enrollment Agreement for Active Duty Military

Thank you for your application to Austin Peay State University! Currently, your admissions file is incomplete; however, you will be allowed to register for your applied term with the completion of this agreement. Persons using this form are not officially admitted and will not be eligible to receive class credit or financial aid. Transferability of credit may not be evaluated at the time of admission and registration. By completing the following agreement, you certify your understanding and intend to comply with all included provisions of this agreement, including timely completion of your admissions file. Please complete all of the following items which pertain to your academic record:

High School/GED/HiSET Test Scores:

Complete high school transcript showing graduation date

GED test scores

HiSET test scores

Official transcripts must be sent directly from your high school and/or your GED testing center to the Admissions Office. Transcripts stamped issued to student are not official.

Colleges/University Transcripts

Total number of official transcript(s) from all previously attended colleges/universities:

Total number of transcripts needed:Official transcripts must be sent directly from your previously attended colleges and/or universities to the Admissions Office. Transcripts stamped issued to student are not official.

Academic Standing

Are you in good academic standing at previous college(s)?:

Yes

No

Are you on probation?:

Yes

No

Are you on suspension?:

Yes

No

How many transfer credits do you have?

Military Transcripts

JST or CCAF. Required of all active duty military.

Placement Test

Please check this box if you are a freshman under 21 years of age, without valid ACT or SAT scores, or a freshman 21 years of age and over, or a transfer student with no college-level English composition, math, history or political science. Upon request, placement requirements are waived for one term only for deployed active duty military. If deployed, you must take the placement test when you return to the US prior to registration for the next term.

Transcript Submission

Any reason you cannot have transcripts sent?:*

Yes

No

To be officially admitted, you are required to have submitted an official transcript from each school you have previously attended. Is there any reason you cannot have your transcript(s) sent to APSU by June 11, 2021 for Summer III Fort Campbell, July 12, 2021 for Summer Clarksville campus, or September 5, 2021 for Fall Clarksville Campus?

Where and When will you Apply?

Main Campus:

Spring (Jan-May)

Summer I (June)

Summer II (July)

Maymester (May)

Fall (Aug-Dec)

Ft. Campbell Campus:

Spring I (Jan-Mar)

Spring II (Mar-May)

Summer III (May-July)

Fall I (Aug-Oct)

Fall II (Oct-Dec)

Residency

TN/KY Time of Residency:How long have you lived continuously in Tennessee or Allen, Calloway, Christian (including Fort Campbell), Logan, Simpson, Todd or Trigg counties in Kentucky?

Submission

I understand that I have not been officially admitted and that I must supply the Office of Admissions with complete and official transcripts. I further understand that if I fail to do this or if my transcripts and/or scores of previous institutions fail to meet admission requirements, my temporary enrollment, course registration, and grades may be canceled, and I may be held responsible for some or all tuition and fee charges

Name: *

Cell Phone Number:Format: (xxx) xxx-xxxx

Email Address:

Date of Birth:*

EMERGENCY CONTACT INFORMATION

Emergency Contact Name:

Emergency Contact Relationship:

Telephone Number:Format: (xxx) xxx-xxxx

Address: