GRADUATE & UNDERGRADUATE

APPLICATION FOR ADMISSION

Admissions@ColumbiaSouthern.edu | FAX: 251.224.0540 | 21982 University Lane | Orange Beach, AL 36561

Mr. ✔ Ms. Miss Mrs. Dr.

HA
NAME (First) _________________________________________ THU
(Middle) _________________________________________ NGUYEN
(Last) ________________________________________________
No 21/Alley 17 Khuong Ha, Khương Dinh, Thanh Xuan
ADDRESS ________________________________________________________________________________________________________________________________________________
Hanoi
CITY _________________________________________ Vietnam
STATE/PROVINCE _______________ POSTAL CODE _______________ COUNTRY ________________________________
thuha118@gmail.com
E-MAIL __________________________________________________________ augustnth@gmail.com
ALTERNATE E-MAIL ____________________________________________________________________
+84
TELEPHONE Home (_________) _____________ - _______________ Cell (_________) 987758368 - _______________ Business (_________) _____________ - _______________
______________
Married
MARITAL STATUS ______________ MAIDEN NAME _______________________ S.S.# ________- 012634240
_________ - ______________ SEX Male ✔ Female Not Disclosed
11
DATE OF BIRTH _________ 08
| _________ 1987
| ________________ ETHNIC AFFILIATION: Are you Hispanic or Latino? Yes ✔ No

ARE YOU A NONRESIDENT ALIEN OF THE UNITED STATES? ✔ Yes No

RACE (check one) American Indian or Alaska Native ✔ Asian Black or African American Native Hawaiian or Other Pacific Islander White
RV GROUP Company
CURRENT EMPLOYER _______________________________________________________________ Business Manager
JOB TITLE ______________________________________________________
IS YOUR ORGANIZATION A CSU LEARNING PARTNER OR CSEG ALLIANCE ORGANIZATION? Yes ✔ No I do not know
WHERE DID YOU LEARN ABOUT COLUMBIA SOUTHERN UNIVERSITY? (Please include details in the space provided.)
✔ Internet Referral Magazine or Newspaper Learning Partner Visit Email Television/Cable Military Visit Conference/Tradeshow Other Billboard
Details _____________________________________________________________________________________________________________________________________________________
Examples: name of search engine used (such as Google, Yahoo, Bing or other); name of magazine or other print source; name of Learning Partner or CSU representative
CHECK ALL THAT APPLY
I am a military Servicemember. I am a veteran and will not be using my VA benefits.
Branch _____________________________ I have previously used my VA benefits.
I am active military and would like to receive information I am planning to use Financial Student Aid (FSA).
on using Tuition Assistance or DANTES benefits. I have already submitted my FAFSA with the CSU school code of 041215.
I am active military and plan to use my Tuition Assistance benefits. I am a spouse or dependent of a veteran.
I am a veteran and would like to receive information on using VA benefits. I am a spouse of an active duty military member.

SELECT A PROGRAM (SELECT ONE)

INDICATE STATUS ✔ First-Time Degree Certificate-Seeking Student Transfer Student Returning Student Non-Degree Seeking/Transient Student

UNDERGRADUATE CERTIFICATE Health Information Science Information Technology

Environmental Management TRACK I, Medical Coding Emphasis Occupational Safety & Health
Finance TRACK II, General Curriculum Emphasis Fire Science
Fire Science Occupational Safety & Health Organizational Leadership
Hospitality & Tourism BACHELOR Psychology
Human Resource Management Business Administration MASTER
Information Technology General ✔ Business Administration

International Management Finance ✔ General

Management Hospitality & Tourism Finance
Marketing Human Resource Management Health Care Management
Occupational Safety & Health Information Technology Human Resource Management
Project Management International Management Marketing
Sport Management Management Project Management
GRADUATE CERTIFICATE Marketing Public Administration
Environmental Management Project Management Criminal Justice Administration
Finance Sport Management Emergency Services Management
Health Care Management Criminal Justice Administration Occupational Safety & Health
Human Resource Management Arson Investigation General
Marketing Emergency Medical Services Administration Environmental Management
Occupational Safety & Health Environmental Management Organizational Leadership
Project Management Fire Administration Public Administration
Public Administration Fire Investigation General
ASSOCIATE Health Care Administration Criminal Justice Administration
General Studies Emergency Medical Services Management Emergency Services Management
Business Homeland Security Public Health
Criminal Justice Human Resource Management General
Fire Science Information Systems Security Community Health Education
General DOCTORAL
Homeland Security Business Administration (DBA)

At Columbia Southern University, our vision is to change and improve the lives of our students through education. In your own words, tell us how
you hope this program will help you change and improve your life.

Rev. 02.18
PREVIOUS EDUCATION
Applicants for admission must possess a high school diploma or its equivalent at the time of admission. To be considered for unconditional admission to an undergraduate
program, applicants must submit the following: A complete application, which includes, but not limited to, a valid phone number, email, physical address, and Social
Security number (SSN), if applicable.

Conditional admission allows applicants who have self- certified graduation from an approved high school program or the equivalent on the CSU application for admission
to enroll in a program for 12 semester hours pending the receipt of required admission documents.

SECONDARY EDUCATION
NGUYEN TAT THANH
High School ________________________________________________ HANOI
City _____________________________ May | ___________
State ____________ Graduation Date _______ | _______ 2005
General Education Diploma (GED) _______________________________________________________________ State ____________ Date Received _______ | _______ | ___________

POSTSECONDARY EDUCATION AND ACADEMIC TRANSCRIPTS:

A student may send copies of transcripts or documents during the initial admission stages and enroll as a Conditional Student. The student must provide official
transcripts prior to completing 12 undergraduate/ 6 graduate credit hours or future enrollments will be delayed. Students who intend to use Federal Student Aid are
required to list all postsecondary institutions previously attended and the number of credit hours completed. In the space below, please indicate which schools will be
providing us official transcripts.
NAME OF INSTITUTION DATE GRADUATED (If Applicable) DEGREE EARNED (If Applicable) CONCENTRATION CREDITS EARNED

HANOI UNIVERSITY OF PHARMACY MAY, 2010 B.PHARM GOOD

HANOI UNIVERSITY OF PHARMACY SEP, 2015 MASTER OF PHARMACY GOOD

YOUR NAME AS IT WILL APPEAR ON TRANSCRIPT(S)

NGUYEN THU HA
____________________________________________________________________________________________________________________________________________________________

PROFESSIONAL LICENSES, CERTIFICATIONS, AND TRAINING: ✔ YES, I will send professional training certificates. NO, I will not send professional training certificates.
CSU uses the guidelines established by ACE (American Council on Education) to determine if certain professional licenses, certificates, training programs, and military training
warrant the awarding of academic credit. Submit all professional licenses and/or certifications that have listed the number of CEU’s awarded and/or classroom contact hours.

ADMISSIONS STATUS
SELECT ONE:
✔ I wish to enroll in courses immediately after submitting my application.
(Not eligible for Title IV) I understand that my Admission Status will be “Temporary” pending the completion of my transfer credit evaluation. While “Temporary,” I may
complete up to 12 undergraduate/ 6 graduate credit hours and must accept responsibility for enrolling in courses required by my selected program and that I am certain
will not be transferred to CSU. I understand that I must submit all official transcripts, and once received, they will be reviewed for qualitative and quantitative
requirements of admission. Once I have met these requirements I will receive an Application Evaluation Report and my admission status will be changed. I have read the
Admission Status Policy, CSU Admission Requirements, and the Transfer Credit Policy and I understand admission may be denied should I not meet all requirements.
I wish to wait on enrolling in courses until my Application Evaluation Report is completed so that I will know what transfer credit CSU has accepted and what courses
are required before I begin my degree program with CSU.
_________________________________________________________________________________________________________________________________________________

By signing this application, I am certifying that I have successfully completed graduation requirements from the approved high school program, or equivalent. By signing this
application, I agree and acknowledge that Columbia Southern University may contact me via SMS text regarding the admissions process and any communication thereafter.

Nguyen Thu Ha
APPLICANT SIGNATURE ____________________________________________________________________________________________ 06
DATE: _______ Jan
| ________ 2023
| ______________

Rev. 02.18