Stand Alone Certificate Application

How to Apply: Applicants to August University as a Post-Baccalaureate student must submit the following:

Application for Admission
Transcript showing Proof of Baccalaureate Degree
Verification of Lawful Presence (if seeking in state tuition)

Additional documents may be requested based on your residency status. Please contact Office of Academic Admissions at admissions@augusta.edu or 706.737.1632 should you have any questions.

Semester you would like to attend:

Certificate Program

Personal Information

Legal First Name

Preferred First Name

Middle Name

Last Name

Other (Maiden)

Birthdate

Social Security Number

Sex

Do you identify as Hispanic?

What race(s) represent you?

Contact Information

Please enter your Permanent Address:

Country

Street

City

Region

Postal Code

Is your Mailing Address the same as your Permanent Address?

Mailing Address

Country

Street

City

Region

Postal Code

Primary Phone

Mobile Phone

Would you like to receive text messages from Augusta University?

Email Address

DeleteParent _ID_
Parent Information
Relationship First Name Last Name Highest Degree Earned Primary Phone Email

Add Parent

Emergency Contact Information

Relationship

Relationship First Name

Relationship Last Name

Primary Phone

Citizenship and Residency Information

Citizenship Information

Citizenship Status

Citizen = USA (hidden)

Country of Citizenship

Visa Status (if applicable)

Please upload a copy of both sides of your Permanent Residency Card, I-551.

First Language

If you are a dependent, are you a dependent of any of the following? (optional)

Which branch?

Residency Information

Are you applying for In-State Tuition?

How old will you be on the first day of class?

As of the first day of classes for the term you are applying, will Georgia have been the present and permanent home (domicile) for at least 12 consecutive months of your parent or legal guardian?

Has your parent/legal guardian ever lived outside of GA?

Date parent/Legal Guardian Started Living in GA? (MM/YYYY)

Does your parent/guardian have a permanent home outside of GA?

If your parent/guardian has a vehicle, in what state is it registered?

If your parent/guardian has state issued ID, what state is it from?

If your parent/guardian is registered to vote, in what state?

If your parent/guardian filed income taxes last year, in what state did they file as a resident?

What is the relationship you have with the person that claimed you as a dependent?

As of the first day of classes for the term you are applying, will Georgia have been your present and permanent home (domicile) for at least 12 consecutive months?

Have you ever lived outside of GA?

Date you started living in GA?

If you have a state issued ID, what state is it from?

If you have a vehicle, in what state is it registered?

If you filed income taxes last year, in what state did you file as a resident?

Education Information

College Receiving/Received Bachelor's Degree:

Attended from:

Attended to:

Material Upload

To complete your application, please attach your Verification of Lawful Presence (required for in-state tuition rate) below.

Verification of Lawful Presence
(a driver's license is the most common form of verification)

Submission

Augusta University is committed to maintaining a safe environment for all members of our community. All applicants must answer these questions. Your application will not be processed without these responses. An affirmative answer to any of these questions does not automatically bar admission to the institution, but does require review. You are required to provide an explanation for each instance you answer Yes. The statement will be used in the review process.

Have you ever been convicted of or plead guilty to a crime other than a minor traffic offense?

Please briefly describe the criminal offense to include the offense, the date of the offense, and what you have done to avoid a repeat offense. In some circumstances you may be asked to provide additional information and/or documentation beyond the information below?:

Are there any criminal charges currently pending against you?

Please briefly describe the pending criminal offense to include the offense, the date of the offense, and what you have done to avoid a repeat offense. In some circumstances you may be asked to provide additional information and/or documentation beyond the information below:

Do you currently have disciplinary or academic misconduct charges pending against you from a high school, college, or university?

Have you ever been disciplined, suspended, or expelled for conduct code violations from a high school or a postsecondary educational institution?

Please Explain:

At the time you left your previous high school(s), college(s) or universities, were you the subject of any disciplinary or academic misconduct proceeding?

Upon submitting your application, a $55 application fee will be required and payable in your application portal. Login instructions to this portal will be sent within 24 - 48 hours.

After reading and confirming, type your name in the certification field below as you would sign an official document:

I hereby certify that, to the best of my knowledge, all statements herein are true, correct, and complete and that I have not omitted any information requested. I understand that submission of erroneous information, whether intentional or unintentional, may nullify my admission. I understand that if I am not admitted to the program of my first choice, I may be recruited by other Augusta University programs for which I am eligible.

All personal data and special categories of sensitive personal data collected or processed by the USG must comply with the USG Cybersecurity Plan, as authorized by the Board of Regent Policy Manual Section 10.4 Cybersecurity. Anyone suspecting his or her sensitive personal data has been exposed to unauthorized access, report your suspicion to helpdesk@usg.edu. Otherwise, questions concerning general data privacy can be forwarded to dataprivacy@usg.edu.

Signature (below) and submission of this application provides consent to and acknowledgement of the USG Privacy Policy.

I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution.

Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete. I certify that all information provided on this Application for Admission may be used to determine my eligibility for scholarships. In regards to scholarship eligibility and in compliance with the Buckley Amendment, I agree to release appropriate information for publicity purposes.

As a condition of acceptance to this institution I agree to actively participate in all assessment testing as required by the University System of Georgia, Augusta University, and/or my major.

Electronic Signature: