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ASU Mid-South | West Memphis, Arkansas

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Application for Admission

Please complete every item on this form that applies or required. Sign, date, and submit the application for processing.

  • General Information

  • If No, you cannot use this form! Please contact our admissions office.
  • xxx-xx-xxxx
  • Have you attended one of the ASU System schools under a different name than you are currently applying? Social Security Number and Driver’s License are required for name change.
  • Residency Information

  • Have you been a legal resident of Arkansas for at least 6 months?
  • What is your country of citizenship? Note: Resident International Students must submit an I-20.
  • Demographic Information

  • Arkansas State University Mid-South is committed to equal access and employment of all qualified persons regardless of race, color, religion, sex, national origin, age, disability, DNA information, veteran status, or other unlawful factors. Inquiries regarding the non-discrimination policies should be directed to the Vice Chancellor for Student Affairs, 2000 West Broadway, West Memphis, Arkansas 72301. Telephone: (870) 733-6786. The following information does not affect the Admissions process. It is confidential and is collected for required state and federal reporting purposes only.
  • Enrollment Status

    Pick One
  • College Plans

    If you plan to seek a degree at ASU Mid-South, please select one. NOTE: YOU MAY ONLY SELECT ONE FROM THE FOLLOWING 3 CATEGORIES!
  • *These programs require a Program Application once all pre-requisites are met.
  • Select one of the following:
  • Please list all previous colleges/universities attended.
    Example - College, City, State, Years Attended, Degree Earned.
  • College, City, State, Years Attended, Degree Earned.
  • College, City, State, Years Attended, Degree Earned.
  • High school students should list parent or legal gaurdian
  •    
  • Immunization Info:

    Students born after 12/31/1956, must provide proof of two (2) doses of measles and rubella (MMR) immunization.

  • All male U.S. citizens ages eighteen (18) to twenty-six (26) must register with the Selective Service before registering for classes. This requirement does not apply to veterans and others exempt by federal law. Please check one of the following:
  • All male U.S. citizens ages eighteen (18) to twenty-six (26) must register with the Selective Service before registering for classes. This requirement does not apply to veterans and others exempt by federal law. Please check one of the following:
  • The ASU Mid-South Campus Safety and Consumer Information Report is available on the college website, www.asumidsouth.edu or click here.
  • Disability Services:

    The Director of the Dr. Barbara C. Baxter Learning Success Center has been designated as the College’s Coordinator of Disability Services. The office is located in the Reynolds Center on the South Campus, and can be contacted at the following email: accessibility@asumidsouth.edu Student and employee complaints related to the denial or neglect of disability accommodations should be addressed to the Director of the Barbara C. Baxter Learning Success Center, the college’s compliance officer for Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act. The Director’s office is located in the Reynolds Center on the South Campus, and can be contacted at the following email: accessibility@asumidsouth.edu

  • NOTICE:

    Students must have official high school or GED transcript, official transcripts from all previous colleges, necessary placement scores, and their immunization record on file with Arkansas State University Mid-South at the time of enrollment. Students who do not provide official transcripts and/or proof of the required immunizations will be prevented from registering for classes the next semester. The ASU Mid-South Crime Report is available on the college website, www.asumidsouth.edu.

  • Non-discrimination Statement

    Arkansas State University Mid-South does not discriminate on the basis of race, color, religion, gender identity, sexual orientation, national origin, age, sex, disability, genetic information, veteran status or marital status in any of its practices, policies or procedures, and provides equal access to the Boy Scouts and other designated youth groups. This includes, but is not limited to, employment, admissions, educational services, programs or activities which it operates or financial aid. The following persons have been designated to handle inquiries regarding the non-discrimination policies: Jeremy Reece Title IX Coordinator Arkansas State University Mid-South 2000 West Broadway West Memphis, AR 72301 Phone: 870.733.6786 Email: jreece@asumidsouth.edu Stephanie Krehl ADA Coordinator Arkansas State University Mid-South 2000 West Broadway West Memphis, AR 72301 Phone: 870.733.6790 Email: accessibility@asumidsouth.edu For further information on notice of non-discrimination, visit http://wdcrobcolp01.ed.gov/CFAPPS/OCR/ contactus.cfm for the address and phone number of the office that serves our area, or call 1-800-421-3481.

  • All applicants must read and sign the following:

    I certify that the information on this application is complete, accurate and true. I further certify that I understand giving false information or withholding information may make me ineligible for admission or to continue my enrollment at Arkansas State University Mid-South. Should any information change prior to enrollment, I will immediately notify the Registrar’s Office.

  • This field is for validation purposes and should be left unchanged.

IMPORTANT!

Please print and sign the signature page. Email, fax, mail or hand deliver to the admissions office.

Contact Information:
Fax:
870-733-6719
Email:
admissions@asumidsouth.edu
Mail:
Admissions Office
2000 West Broadway
West Memphis, AR 72301


CLICK HERE: APPLICATION FOR ADMISSIONS SIGNATURE PAGE

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ASU Mid-South

2000 West Broadway

West Memphis, AR 72301

Main – 870.733.6722
Admissions – 870.733.6728
Financial Aid – 870.733.6729
Toll Free – 866.733.6722

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