Last name:

First name and M. I.:  

Mailing Address:

Soc. Sec. No.: (no dashes)  

Phone No.:

E-mail Address:

A. RESIDENCE CLASSIFICATION

A Louisiana "resident for tuition consideration" is defined as one who has abandoned all prior domicile and has been domiciled in the State of Louisiana continuously for at least one full year (365 days) immediately preceding the first day of classes of the term for which resident classification is sought. The individual's physical presence within this state for one year must be associated with substantial evidence that such presence was with the intent to maintain a Louisiana domicile. Physical presence within the state solely for education purposes without substantial evidence of the intent to remain in Louisiana will not be sufficient for resident classification regardless of the length of time within the state.

NON-LOUISIANA RESIDENTS

I understand that I do not qualify as a Louisiana resident for tuition consideration for the term for which this application is submitted.

___________________________________                    _____________________

SIGNATURE (IN INK)                                                   DATE

LOUISIANA RESIDENTS

This section must be completed in full for the purposes of determining whether you are a Louisiana resident for admission consideration and/or if you claim Louisiana residency for tuition consideration. Copies of documentation such as income tax forms, voter registration, vehicle registration, and driver's licenses may be required to determine residency status upon admission. Please check all of the following criteria that apply to you.

I am an independent person and have maintained legal "residence for
tuition consideration" as defined under RESIDENCE CLASSIFICATION in Section A above.

I am a dependent person and my parent or legal guardian has maintained
legal residence in Louisiana for at least 12 months. 

I am married to a person who has maintained legal residence in Louisiana for at least 12
months.

I am the dependent of a person or married to a person who has abandoned their out of state domicile and moved to Louisiana to work. 

I am an unmarried dependent or spouse of a full-time University employee.

I am a member of the armed forces currently stationed in Louisiana on active duty.

I am a dependent of a member of the armed forces currently stationed in Louisiana on active duty.

I am a dependent of a person who was eligible to be classified as a resident of Louisiana for at least two years and has moved to another state continuously for a period of no longer than five years or outside the State of Louisiana continuously for a period of no longer than 10 years.

SELECTIVE SERVICE 

U.S. males between the ages of 17 and 26 must complete this section.

I hereby swear or affirm under penalty of perjury, in accordance with the requirements of the Military Selective Service Act and the requirements of Louisiana State Law R.S. 17:3151, the following: (check one)

I have registered or will register with the Selective Service {Registration with the Selective Service must be completed before University enrollment).

I am not required to register with the Selective Service System because: (check one)
          I am under 18 years of age.

          I am in the armed forces of the United States on active duty other than in a reserve or national guard unit.

          I am a veteran of the armed forces of the United States and I am submitting my DD Form 214. 

          I am excused from registration for any other reason provided by federal law and that reason is:   

I hereby certify that the information given in this application and in all attachments requested is true, correct and complete to the best of my knowledge. I authorize the Louisiana State University to verify all facts relevant to my claim for residence. I also certify that (if applicable) I have registered (or will register) and have complied with the Selective Service Act.
 

___________________________________                    _____________________

SIGNATURE (IN INK)                                                   DATE

B. VETERINARY MEDICAL EXPERIENCE

Describe your experience working with veterinarians specifying the precise nature of your activities and duties and identifying the veterinarians by name, address, telephone number and work interval (e.g. from 9/00  to 3/01). You may want to create this item as a separate text only file using a word processing program and then copy and paste into the text box below. (IMPORTANT: If you paste the file into the textbox, the file must be text only. Fancy fonts, bolding, underlining, etc. will not paste into the text box. All text MUST be visible in the text box.)

C. ANIMAL EXPERIENCE

Describe your experiences with animals gained in an animal shelter, kennel, laboratory, zoo, on a farm or ranch, at your home caring for your pets, or any other setting. You may want to create a separate text only file on a word processing program and then copy and paste into the text box below. (Important: If you paste the file into the text box, it must be text only. Fancy fonts, bolding, underlining, etc. will not paste into the text box. All text MUST be visible in the text box.)
 

D. OTHER RELATED EXPERIENCES

Describe any educational, volunteer, or job-related experiences that may have prepared you for a veterinary medicine career. Areas such as health care, research endeavors, publications, community programs, etc. can be included in this section. You may want to create a separate text only file on a word processing program and then copy and paste into the text box below. (Important: If you paste the file into the text box, it must be text only. Fancy fonts, bolding, underlining, etc. will not paste into the text box. All text MUST be visible in the text box.)

E. LEARNING ENVIRONMENT DIVERSITY

Diversity has been shown to be an important factor in enhancing the learning environment. In the space provided please state how your background and experience will add to the cultural, ethnic, experiential, educational, and/or geographic diversity of the veterinary class to which you are applying.

Please review your application for errors before printing. Mail printed application along with a $50 check or money order payable to Louisiana State University to :

If you wish to submit additional pages for Sections B, C, D, or E, they must be typed and attached to this printed application.

Clicking the Reset button will clear the entire application for reentry of information.