Testing

UMPI YourPace Program

Preferred Start Term*

Fall 2018 - October Start

Pick a Major*

Name and Contact Information

Name*

First Middle Last Suffix

Preferred First Name

Other Names

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone*

Work Phone

Cell Phone

Cell Phone Communications

I wish to receive automated calls or text messages at the provided Cell Phone number

Email*

Enter Email Confirm Email

Demographic Information

Date of Birth*

Gender*

SSN*

Current Citizenship Status*

Permanent Resident Alien Card ID

Citizenship*

Country of Birth*

Please select one or more of the following racial categories to best describe yourself

American Indian or Alaskan Native
Asian
Black or African American
Franco American
Hispanic/Latino
Native Hawaiian or other Pacific Islander
White
Other

Other (please specify)*

What is your current U.S. Armed forces status?

Are you eligible for veteran benefits?

Do you intend to apply for financial aid consideration?

Academic History

High Schools Attended

Please provide information on high school/post graduate high school attended listing most recent first.
Please request an official transcript be sent to the Application Processing Center, PO Box 412, Bangor, ME 04402-0412
Click the plus (+) icon below to add additional high schools

High School Name	City	State	Country	Graduation Date

Did you receive your high school equivalency diploma through the GED, HiSET or TASC examination? If so, please provide the date awarded.

Date Awarded*

College Information

Please provide information on all colleges you have attended starting with the most recent first.
Click the plus (+) icon below to add additional colleges

College Name	City	State	Attend Start Date	Attend End Date

Please provide an official transcript from each college attended.
Official transcripts can be sent to:
Application Processing Center, PO Box 412, Bangor, ME 04402-0412
Transcripts are required whether credit was earned or not.

Prior Learning Assessment

I have AP, CLEP or other credit-by-exam transcripts to submit
I am interested in learning more about earning credit for learning I did through work and/or other experiences

Background Information

Have you ever been found responsible for a disciplinary violation at an educational institution you have attended from 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in your suspension, removal, dismissal or expulsion from the institution?*

Yes
No

Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? Note that you are not required to answer "yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise required by law or ordered by a court to be kept confidential. Applicants are expected to immediately notify the UMS institutions to which they have applied should there be any changes to the information requested in this application, including disciplinary history.*

Yes
No

If you answered yes to either or both questions, please provide below information that gives the approximate date of each incident and explains the circumstances. Also, please note that if you answered yes to the second question and the event happened within the last 10 years, you will need to provide court documentation.*

Comments

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UMPI YourPace Program

Name and Contact Information

Demographic Information

Academic History

Background Information

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