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This form is for students enrolled in the Community College System of New Hampshire who wish to transfer to the
University of New Hampshire, Plymouth State University, Keene State College, or Granite State College. There is
no
application
fe
e.
Please meet with your CCSNH or GSC Academic Advisor to review and complete this form.
GSC
A
d
m
i
ss
i
ons
KSC
A
d
m
i
ss
i
ons
PSU
Admissions
UNH
A
d
m
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UNHM
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ons
25 Hall Street
Concord, NH 03301
229 Main Street
Keene, NH 03435
17 High Street
Plymouth, NH 03264
3 Garrison Avenue
Durham, NH 03824
88 Commercial St
Manchester, NH 03101
(603) 513-1339 (603) 358-2781 (800) 842-6900 (603) 862-1360 (603) 641-4150
Rolling admission:
May apply a
ny
ti
m
e 4
terms/year – Fall,
Winter, Spring, or
Summer
DUE: April 1 for the
Fall semester
;
December 1 for the
Spring semester
DUE: May 1 for the Fall
semester; December 1 for
the Spring semester
DUE: April 1 for the
Fall semester
;
November
15 for
the Spring semester
DUE: June 15 for the
Fall semester
;
November 15 for the
Spring semester
PLEASE PRINT USING BLACK INK
Semester/year for which you are
applying
(select one only):
Fall 20
Spring 20 Summer (GSC Only) 20 Winter (GSC Only) 20
Full Time Part Time
Name:
Last (include any former last names) First Middle
Permanent
Mailing
Ad
d
r
ess:
Street or P.O. B ox Apartment #
( )
City/ Town State Zip code
Telephone
E-mail Address:
Birthdate:
(MM/DD/YY)
Gender: Male Female
Are you a U.S.
citizen?
Yes No
If no, do you have permanent U.S. resident status? Yes No
If yes, how long have you resided in the U.S.?
Please provide confirmation of your status by enclosing a copy of your
permanent resident card or visa documents.
Are you Hispanic/Latino (including Spain)?
Yes No (Optional)
Regardless of your answer to the above question, please indicate how you identify yourself. (Optional)
American Indian/Alaska Native (including all Original Peoples of the Americas )
Asian (including Indian subcontinent and Philippines)
Black or African American (including Africa and Caribbean)
Native Hawaiian or Other Pacific Islander (Original Peoples)
White (including Middle Eastern)
Has either parent completed a bachelor’s or graduate degree? Yes No
Military status (check all that apply):
Current Active Duty
Veteran
Drilling National Guard
Drilling Reservist
If you have been discharged, please submit a copy of your military form DD-214 indicating the nature of your discharge.
Please complete the other side
May we send you occasional text messages? Yes No
Choose your major at: GSC KSC PSU UNH UNHM (select one) Please visit that institution’s website to review major options.
1
st
Choice Major: 2
nd
Choice Major:
High School/College(s) attended:
High School/College City/State Dates Attended Graduation Date
College City/State Dates Attended Graduation Date
College City/State Dates Attended Graduation Date
College City/State Dates Attended Graduation Date
If you are currently enrolled in coursework, please list your classes below:
I am not currently enrolled in coursework.
Course #
Course Title
Semester
College/University
Credit
Have you ever been judged guilty or convicted of a misdemeano
r, felony or other crime? *
Yes No
(NOTE)
You are not required to
answer “yes” or provide an explanation if the criminal judgment or conviction has been expunged, sealed,
annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.)
Have you ever been suspended, placed on probation, or dismissed from any College or University for any academic or disciplina ry
reasons or
incurred other formal disciplinary action?*
Yes No
If you answer “yes” to either of the following questions, please attach a separate sheet that gives the approximated date of each
incident, explains the circumstances, and reflects on what you learned from the experience:
*
Any changes in these conditions will require you to notify the Office of Admissions within 14 days.
NH Residency: If your residency has changed since a previous application, or if you have not previously applied, you will need to make a cl aim to
in-state status with a notarized residency statement. Please contact the appropriate Admissions Office or visit their web site to request a residency
form.
ALL Applicants: I have completed this form accurately and thoroughly. By signing below,
I authorize CCSNH and USNH, including its online
enrollment center and the institution to which I am applying, to disclose and share my education records for the purpose of facilitating my application
and enrollment.
Signature of Applicant Date
Signature of CCSNH or GSC Academic Advisor Date
Rev. 09/16
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Completed 13 August 2021

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