LSUE Academy Application for Admission

FULL LEGAL NAME REQUIRED

Last Name:*

First Name:*

Middle Name:

Social Security Number:Providing your SSN is not mandatory. If you choose to omit your SSN, you WILL NOT be eligible to receive federal financial aid. SSNs are kept private and safe, and it is beneficial for you to provide it on your application.

Date of Birth*

Mailing Address:*Number, Street, Apt.

City:*

State:*

Zip Code:*

Sex:

Male

Female

Ethnicity:

Asian

Black/African

Caucasian

Hispanic, Latino, or Spanish

Native American

Pacific Islander

Other

Prefer not to answer

Select all that apply.

Contact Phone:*

Email Address:*

ENROLLMENT INFORMATION

Semester and year you plan to attend:*

Where will you take Dual Enrollment courses? (click all that apply):

On High School Campus

Online

LSUE Campus in Eunice

Have you previously attended the LSUE Academy?

Yes

No

If you have previously attended college, submit the name(s) of the institution(s):

Degree Program:*

Intended educational goal:

Transfer to a 4-year University to complete bachelor's degree

Finish at LSU Eunice to complete associate's degree or certificate

Unsure

ACADEMIC AND RESIDENCY INFORMATION

High School:*

Expected High School Graduation Date:*

IMMUNIZATION
All students born after 1956 must provide proof of immunization for mumps, measles, rubella, and tetanus/diphtheria OR they must agree to waiver claiming exemption from the immunization requirements. In compliance with Act No. 251 of the 2006 Regular Session of the Louisiana Legislature, LSU Eunice also requires that all students provide satisfactory evidence of current immunization against meningococcal disease. Students will not be allowed to complete registration unless they have furnished proof of immunization for all above listed diseases or agree to this waiver.

Your immunization record can be emailed to admissions@lsue.edu or you can agree to waive by clicking the button below.

I agree to this waiver claiming exemption from the immunization requirement. I understand that by claiming exemption for medical, personal, or religious reasons, or lack of availability, that I may be excluded from campus and from classes in the event of an outbreak of measles, mumps, rubella, tetanus, diphtheria, or meningitis until the outbreak is over or until I submit proof of immunization.

Do you agree to waive the requirement to submit immunization records?

I Agree

STUDENT CERTIFICATION
By checking the Student Certification box below, I understand that, once registered in an LSUE Academy class, I am an LSUE student subject to all rules, policies, and procedures required for all LSUE students as published in the LSUE Catalog, Student Handbook, Code of Student conduct, and other official announcements.

I understand that I am enrolling as an LSUE Academy Student at LSUE. If I desire to enroll at LSUE after high school graduation as a regular, degree-seeking student, I must apply for admission as a regular student.

I understand that the high school and college grades are earned in LSUE Academy courses will be on my permanent high school and college academic records.

I understand that the grades I earn in LSUE Academy college courses will be used by other programs, including TOPS, to determine my continuing eligibility for those programs.

I hereby authorize my high school authorities, my school district authorities, and LSUE to exchange and discuss my academic records for any purposes related to my eligibility for, documentation pertaining to, or participation at LSUE.

I understand that it is my responsibility to OFFICIALLY WITHDRAW from by LSUE's published deadlines, any class I decide not to complete.

Student Certification

I certify that I am the student applicant and that I understand and agree to the above terms.

PARENT CERTIFICATION
(for students under 18 years of age)

As a legal guardian, I grant permission to allow this student to receive credit from LSUE.

I understand that the grades my dependent earns will be on a permanent college transcript of record and will be used by other programs, including TOPS, to determine continuing eligibility for those programs.

I acknowledge that it is my dependent's responsibility to follow published LSUE guidelines if it becomes necessary to OFFICIALLY WITHDRAW from a class.

I hereby authorize authorities from my dependent's high school, my dependent's school district, and LSUE to exchange and discuss my dependent's academic and student records for any purpose related to my dependent's eligibility for, documentation pertaining to, or participation at LSUE.

Parent/Guardian Full Name:*

Parent Last 4 SSN:*

Parent Certification

I certify that I am the parent/guardian of this student applicant and that I understand the above terms.

LSUE Dual Enrollment & Academy Application for Admission