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LANGSTON UNIVERSITY
OFF ICE OF A DMI S S ION S AN D O UTR E AC H P RO GRA M S

UNDERGRADUATE APPLICATION FOR ADMISSION

www.langston.edu
Campus Location: ___Main Campus ___Oklahoma City Campus ___Tulsa Campus

Semester of Entry to Langston: ___Fall, August 20___ ___Spring, January 20___ ___Summer, June 20___

Please Print In Blue or Black Ink or Type. Do Not Use Pencil

Before mailing please be sure you have: (1) answered all questions completely (3) verified your social security number
(2) signed and dated this application (4) attached required transcript(s)

1. Applicant’s Full Legal Name:_____________________________________________________________________________________________________________

Last Name First Name Middle Name

2. Other Names Under Which _______________________________________________________________________________________________________________

Your Records May Appear: Last Name First Name Middle Name

3. Social Security Number: __________________________________ Email Address: _______________________________________________________________

4. Military Status: Are you a veteran? Yes No Discharge Date________________________

Information requested regarding the applicant’s race or ethnicity is voluntary, and will be used in a non-discriminatory manner
consistent with applicable civil rights laws.

5. Gender: __Male __Female 6. Date of Birth: _____________________ 7. Place of Birth: _______________________________

Month Day Year City State

8. Race/Ethnic Background: __African American __Asian American __Hispanic __White __American Indian-Tribe

9. Citizenship/Residency: Are you a citizen of the United States? __Yes __No If no, you must complete an international student application.

10. Are you a Resident of Oklahoma: Yes___ No ___ If yes what county: _____________________

11. Current Home Address: _________________________________________________________________________________________________________________

Number Street City State Zip Code

12. Permanent Mailing Address: _____________________________________________________________________________________________________________

Number Street City State Zip Code

13. Home Phone Number: ______________________________ 14. Cell/Work Phone Number: __________________________________________
Area Code Number Area Code Number

15. Name of Parent, Guardian/ Emergency Contact ______________________________________________________________________________________________

Last Name First Middle

16. Address of Parent, Guardian/Emergency Contact _____________________________________________________________________________________________

Number Street City State Zip Code

17. Telephone Number Parent, Guardian /Emergency Contact ____________________________________

Area Code Number

18. Desired Major: _________________________________________________________

19. Enrollment Classification: I am applying to Langston as a:

Degree Seeking Student Non-Degree Seeking Student

__ First-Time Freshman __ Concurrently Enrolled High School Student
__ Transfer Student (Greater Than 6 Credit Hours) __ Personal Enrichment
__ Returning Langston University Student __ Special Student (Limited Enrollment of 9 Credit Hours)
20. High School: ______________________________ Address _______________________City_____________________ State__________

21. High School Graduate? ____Yes ___No If yes, what was your class rank? ____/____ What was your grade point average? ________
Actual or expected date of graduation ________ Do you have a GED? ___Yes ___No If yes, date awarded _____________________
If you earned a GED, Please submit a copy of the GED certificate and score report.
22. Have you taken the ACT? ___Yes ___No If yes, when? _____________Were scores sent to Langston? ___Yes ___No

23. Have you taken the SAT? ___Yes ___No If yes, when? _____________Were scores sent to Langston? ___Yes ___No

24. Are you currently on probation from any college or university? ___Yes ___No
25. Have you ever been suspended or expelled from any college or university? ___Yes ___No
26. Have you ever been convicted of a felony? ___Yes ___No

*If the answer is yes to any of the above questions (24, 25, 26) please attach an explanation of the circumstances to this application.

27. List all colleges, universities, and professional schools attended since high school, including any you are currently attending.
List in order of attendance. If sufficient space is not provided, please list additional schools on a separate sheet of paper. You
must submit official transcripts of college work attempted for EACH college attended, even if no credit was earned. Failure to
report all institutions attended may result in dismissal or loss of credit.

Name of College/Address/City/State Attempted Hours Attended From Attended To GPA

__________________________________________ ___________________ __________________ ________________ ____________

__________________________________________ ____________________ __________________ ________________ ____________
__________________________________________ ____________________ __________________ ________________ ____________
__________________________________________ ____________________ __________________ ________________ ____________

Freshman Applicants
You must submit an official copy of your high school transcript that includes the grades for the first half of your senior year (a seven-semester transcript) if you are
applying during you senior year in high school.
Transfer Applicants
You must submit official transcripts from EACH college or university that you have attended, even if no credit was earned and a final high school transcript.

Readmission Applicants
You must submit official transcripts from EACH college or university that you have attended, even if no credit was earned. Please indicate the semester you were last
enrolled at Langston______________________________________________

Signature (Required of All Applicants)

By my signature below, I certify that:

1. The information provided above is complete and accurate to the best of my knowledge.
2. I understand that Langston University requires official transcripts from my high school and EACH college I have attended and I am responsible for ensuring these
transcripts are sent directly to Langston University.
3. I authorize any high school, university or college I have attended to furnish enrollment, grade, and test score information as may be requested by Langston University.
4. I understand that withholding information requested in this application or giving false information may cause me to be ineligible for admission to, or continuation at
Langston University.
5. I understand that enrollment at Langston University incurs a financial obligation and is the responsibility of the student to pay all amounts owed in a timely manner.

__________________________________ ________________________ __________________________ ___________

Signature Print Name Here Social Security Number Date

Please carefully review your application to determine that all information is complete and accurate. An incomplete application or failure to submit required information
and documents will result in a delay of the University’s Admissions decision. Return completed application to the Office of Admissions at the campus you which to
attend along with a check or money order, written to Langston University for $25.00 non-refundable application fee.

Main Campus Oklahoma City Campus Tulsa Campus

Office of Admissions Office of Admissions Office of Admissions
W. H. Hale Student Success Center 4205 North Lincoln 914 N. Greenwood
P.O. Box 667 Room 150 Student Services
Langston, OK 73050 Oklahoma City, OK 73105 Tulsa, OK 74106
Phone: (405) 466-3428 Phone: (405) 962-1620 Phone: (918) 877-8100
FAX: (405) 466-3391 FAX: (405) 962-1621 FAX: (918) 877-8107
E-mail: [email protected] E-mail: [email protected] E-mail: [email protected]

Langston University, In compliance with Title IV and VII of the Civil Rights Act of 1964, Executive Order 111246 as amended, Title IX of the Education Amendments
of 1972, Americans with Disabilities Act of 1990 and other federal laws and regulations, does not discriminate on the basis of race, color, national origin, sex, age,
religion, disability, or status as a veteran in any of its policies, practices, or procedures. This includes, but is not limited to, admissions, employment, financial aid, and
educational services.

Revised January 2011