Undergraduate Admissions Application - Form III
College of Lifelong Learning

1:

Social Security Number 
3:

Last Name                                          First Name                               M.I.
4.
Street Address                                                                                        Apt.#
City   State  
Zip
5: Contact Number:
6.
Email:
7. Sex:
8.

Race   :
Race: Race:  
Race: Race:        

9.

10.
Date of Birth:  
  11. List your Metro Learning Center:
12. Do you have any physical disabilities: , If yes, please list
13. Are you a transfer student?  Transferred from what Institution?
14.

Highest level of education completed:






15.

My enrollment intent is to: (Check all if apply)



16. Desired area of study:








Students must meet all admissions requirements set forth by Jackson State University and the College of Lifelong Learning. To satisfy undergraduate admission to the College of Lifelong Learning, students must meet the following requirements:

      1. Admission to Jackson State University
      2. Declared an interest in entering the College of Lifelong Learning
      3. Have a GPA of 2.0