DIVISION OF CONTINUING EDUCATION
Verification Signature/Legal Regulations
The following information is required by all applicants to The University of Tulsa.
Please return this form to:
The University of Tulsa
Division of Continuing Education
800 S. Tucker Dr.
Tulsa, OK 74104
1. Have you ever been suspended or dismissed from college for disciplinary reasons?
Yes No
If yes, please name the institution and semester/year: _________________________________
Include an explanation on a separate sheet.
2. Have you ever been suspended or dismissed from college for academic reasons?
Yes No
If yes, please name the institution and semester/year:_________________________________
3. Have you ever been convicted of a felony? Yes No
If yes, include an explanation on a separate sheet of paper.
4. Recent Federal Legislation stipulates that anyone who is required to register as a sex offender in any state or jurisdiction must notify the college he or she attends. In order to be in compliance with this legislation, are you required to register in any state as a sex offender?
Yes No
Failure to explain an affirmative answer to 1 through 3 will not necessarily result in rejection of an applicant for admission. However, failure to answer all questions truthfully (or to disclose information honestly if you responded in the affirmative to any question) will subject an accepted applicant to having the offer of admission rescinded or will subject an enrolled student to the Universityfs student judicial process and may result in dismissal from the University.
I certify that to the best of my knowledge all statements submitted by me on my admission application and on this form are correct, complete, and my own. I am aware that, if I enroll, all portions of my application will become part of my permanent file at The University of Tulsa. I understand that failure to provide accurate and complete information can result in cancellation of the application, and/or revocation of admission and/or enrollment. I also understand my obligation to inform the University if information or circumstances indicated on my admission application or this form should change.
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Please PRINT your full name Social Security Number
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Signature Date
