CPCS Application

Personal Data

First/Given Name

Middle Name

Last/Family Name

Preferred First Name

Previous Name or Other Last Names used

Date of Birth

Sex Assigned at Birth:

Female

Male

If you would like the opportunity, we invite you to share more about your gender identity.

Contact Information

Primary Phone Number

Cell Phone Number

Personal Email Address (please use a non-school email you'll keep long-term, like Gmail or Yahoo)

Mailing Address

Country

Street

City

Region

Postal Code

Citizenship

What is your country of birth?

Primary Citizenship:

Are you a permanent resident of the United States?

Is English your native language?

Please tell us your native language.

Is English the primary language spoken in your home?

Please tell us the primary language spoken in your home.

Are you eligible for student aid as a Veteran or active-duty military member, either as a student or as a dependent? For more information about these education benefits offered by the U.S. Department of Veteran Affairs visit the official U.S. government Web site at http://www.benefits.va.gov/gibill.

Social Security Number

What is your visa status?

Ethnicity

If you wish to be identified with a particular ethnic group, please select the choice that most accurately describes your heritage. No information you provide will be used in a discriminatory manner.

Are you Hispanic or Latino?

Yes

No

Select one or more of the following races:

Intended Program of Study

I am applying as a:

First Year student (I have not attended any other college prior to applying to Adelphi)

Transfer

How many college credits will you have completed by the time you enroll at Adelphi (please only count college credits that are completed after high school graduation):

Semester Applied for:

Are you interested in living on campus?

I plan on attending:

Have you previously applied to Adelphi?

If yes, date (semester and year)

Have you ever taken classes through Adelphi before? Either as a student or through NYSUT, college credits earned at your high school, continuing education classes or a certificate program.

What is your intended level of study?

What is your intended program of study?

Concentration:

First Concentration:

Second Concentration:

*Students coming in with credits in the Natural Sciences, Literature and Criminal Justice can apply their credits to one of the two concentration requirements selected.

Indicate the learning hub location you plan to attend:

In addition to the general admissions requirements, students applying to the AA in Liberal Arts (Pre-Nursing path program) must also submit a copy of their L.P.N. license

Yes, I acknowledge this.

In addition to the general admissions requirements, students applying to the Advanced Certificate for Health Professionals must also submit ACT/SAT scores, Three letters of reference (you must have at least one letter from each of the following: 1- faculty member, highlighting academic abilities, 2- work or volunteer organization, highlighting leadership skills, 3- personal reference, highlighting interest in medicine.

An interview and additional materials may be required on a case by case basis.

Yes, I acknowledge this.

Previous Education

From which school did you earn your high school diploma?
If you earned a high school equivalency, please enter GED/General Equivalency

Date of Your High School Graduation:

1- What school did you earn college credit or a degree from?

2- What school did you earn college credit or a degree from?

3- What school did you earn college credit or a degree from?

4- What school did you earn college credit or a degree from?

5- What school did you earn college credit or a degree from?

If you would like, you can upload an unofficial transcript here:

Additional Information

Are you currently employed by Adelphi University?

Yes

No

Please list department, title and phone extension:

Are you the parent and/or primary caregiver for a dependent, minor child?

Yes

No

Is a relative(s) of yours an alumnus/a, having earned a degree from Adelphi University?

Yes

No

Alumnus/a Name (include maiden, if applicable):

Alumnus/a Relationship to you:

Alumnus/a Date of Graduation:

Have you ever served in the US armed forces?

Yes

No

Statement of Intent

Submit an essay/statement of intent in 500 words or less. You can submit this along with your application or send it separately at a later time on one of the following essay topics:

Explain your reasons for wanting to attend Adelphi University
Describe a personal accomplishment of which you are particularly proud and explain why

Or, type or copy-and-paste your document here:

Disciplinary History

Have you ever been convicted of, or pled guilty or no contest to, a felony or misdemeanor charge? (An affirmative response will not automatically prevent admission, but any omission or falsification is grounds for denial or rescission of admission or for expulsion)

Yes

No

Please explain the following: 1. What were the details surrounding the incident (please be specific)? 2. What was the date of the incident? 3. Were you convicted or did you plead guilty? 4. What was the sanction imposed as a result? 5. Is the case settled?

Have you ever been suspended, dismissed, expelled or required to withdraw from any high school or college for academic or disciplinary reasons? (An affirmative response will not automatically prevent admission, but any omission or falsification is grounds for denial or rescission of admission or expulsion.)

Yes

No

Please explain the following: 1. What were the details surrounding the incident (please be specific)? 2. What was the date of the incident? 3. What was the sanction imposed? 4. What was the duration of the suspension?

Signature

I understand that all confidential recommendations connected to this application will be used solely to evaluate my application and will not be disclosed to anyone, including myself.

I understand that credentials submitted to support my admissions application become the property of Adelphi University.

I certify that all information in my application is accurate and my own work (including writing samples and other materials submitted).

I authorize Adelphi University to contact previous schools to verify my credentials or obtain information in connection with this application.

I understand and agree that any misrepresentation or omission of facts in my application will justify the denial of my application, rescission of admission or expulsion. If I am admitted, I will comply with all the rules, regulations and policies of Adelphi, and I understand that my admission, matriculation and graduation are subject to the control of the authorities of Adelphi.

I grant my high school(s) and all of my previously attended colleges and universities permission to release my transcript(s) to Adelphi University.

Signature

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Please enter today's date.

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