E-Signature Disclosure Notice

This Electronic Signature Notice informs students of the required consent for Salem University to provide students with the ability to electronically sign any and all official school documents. This notice contains important information that we are required by law to provide to you. If you have any questions or concerns about sending and receiving information in electronic form, please feel free to contact us at admissions@salemu.edu or by calling (844) 462-9128.

Your consent applies to all transactions, forms and records that require a legal signature. By consenting, you understand that after electronically signing documents, you may use your browser’s print function to print out the documents for your records. You may also call Salem Univeristy at (844) 462-9128 to request copies of any signed document, which will be mailed at no charge. If you download or print any confidential materials, we encourage you to store them in a secure environment.

This agreement must be signed by the student to complete your application.
THIS IS A BINDING AGREEMENT.

Area of Interest

Personal Information

Educational Record

Colleges Attended Since High School

Other

Scholarship Application

ENROLLMENT AGREEMENT – LEGAL CONTRACT

Salem University, LLC (“Salem”) is a private, proprietary institution of higher learning located at 223 West Main Street, Salem, WV 26426, 304.326.1109. Accredited by the Higher Learning Commission (www.hlcommission.org) 800.621.7440.

I hereby enroll at Salem University for the following Program of Study

Associate’s degree in , which is a minimum of sixty (60) or sixty-six (66) semester credit-hours, program dependent, and takes at least twenty (20) or twenty-two (22) months of continuous successful enrollment to complete, respectively.

Bachelor’s degree in , which is a minimum of one-hundred twenty (120) semester credit-hours, program dependent, and takes at least forty (40) months of continuous successful enrollment to complete.

Master of Business Administration in , which is a minimum of thirty (30) or thirty-six (36) semester credit-hours, program dependent, and takes at least ten (10) or twelve (12) months of continuous successful enrollment to complete, respectively.

Master of Education in , which is a minimum of thirty (30) or thirty-six (36) semester credit-hours, program dependent, and takes at least eleven (11) or fifteen (15) months of continuous successful enrollment to complete, respectively.

Certificate in ,which is minimum of fifteen (15), eighteen (18), twenty-four (24), twenty-seven (27), or thirty-six (36) semester credit-hours, program dependent, and takes at least five (5), six (6), eight (8), nine (9) or twelve (12) months of continuous successful enrollment to complete, respectively.

TUITION

I hereby agree to pay tuition as described below:

  • Tuition: * per initial credit-hour
  • Total Hours: minimum total credit-hours required to complete the Program of Study
  • Total Program Tuition: ** estimated total based on successful completion of all courses without repetition

* Tuition, books, and fees are subject to change upon at least ninety (90) days’ notice to students. Supplies are separate institutional charges and are not included in tuition, books, and fees. Books and fee are as follows per the catalog bulletin:

  • Books $100 per course
  • Technology Fee $100 per semester
  • Activity Fee $100 per semester (resident students only)

** Repeated courses or changes of majors will increase total cost and time to completion. Transfer credits may reduce total cost and time to completion.

METHODS OF PAYMENT

Payments may be made in the form of cash, check, major credit card, and/or through scheduled disbursements of federal financial aid programs. Payment schedules are on a semester basis.

GENERAL PROVISIONS

As a student of Salem, I understand that I will be entitled to the privileges and bound by the conditions below:

Cancellation: I understand that I may cancel this Enrollment Agreement in writing, within five (5) business days of signing the Agreement and before establishing attendance in class, in which case I will be entitled to a full refund of any prepaid tuition, for domestic students only. I understand my application fee is non-refundable.

Financial Obligations: I understand that I am personally responsible for all tuition and other charges arising from and during my enrollment at Salem. I understand that it is my personal obligation to pay all tuition and other charges when due. If I do not pay the full amount of any scheduled payment when that payment is due, I may not be permitted to continue my studies. If I am not able to continue my studies, I understand that I am responsible for any outstanding tuition or other charges due in accordance with Salem’s refund policy. I understand that my academic transcript will not be released to me or to any other party requesting my transcript if there is a balance due to Salem. In addition, if I choose to re-enroll at Salem, I must satisfy any outstanding tuition or other charges prior to my re-enrollment. I understand that any student financial assistance made available to me may not completely cover my tuition and other charges; and I understand that any tuition and other charges not paid by financial assistance is my personal financial obligation.

Instruction: I understand that I will receive instruction in English. Instruction will be delivered by qualified instructors employed by Salem.

Renewal of Enrollment Agreement: I understand and agree that, although this agreement is executed for a period of only one (1) semester, my enrollment at Salem for subsequent semesters shall constitute a renewal of the terms of this agreement except for the tuition charge which may be subject to change with at least ninety (90) days’ notice to students.

Graduation: I understand and agree that I must fulfill all requirements listed in the Salem catalog to graduate from the Program of Study.

RETURN OF FEDERAL TITLE IV AID

Federal regulations require Salem University to calculate a return of Title IV funds for any student who withdraws or does not complete a semester and who has received or was scheduled to receive financial assistance from the Title IV programs. The calculation is performed using a specific formula required by the U.S. Department of Education.

The term Title IV Funds refers to Federal Financial Aid Programs authorized under the Higher Education Act of 1965, as amended and includes Federal Pell Grants, Federal Supplemental Educational Opportunity Grants, Iraq and Afghanistan Service Grants, Federal Perkins Loans, Federal Direct Stafford Loans, and Federal PLUS loans. The calculation for return of Title IV funds is based on the withdrawal date (Last Date of Attendance or “LDA”) as determined by the Registrar’s Office. The number of days completed in the semester is divided by the total number of days in the semester to determine the percentage of semester completed.

If the percentage is 60% or more of the semester completed, there is no return of Title IV funds due and the student has earned 100% of scheduled Title IV funds. If the percentage is less than 60%, this percentage is multiplied by the total amount of Title IV aid scheduled to determine the total amount of Title IV aid earned. The percentage is determined and applied as below:

  • Officially Withdrawn Students – the percentage from the above stated formula (rounded to the nearest one-hundredth) is the amount of Title IV aid earned.
  • Unofficially Withdrawn Students – 50% is the amount of Title IV aid earned by the student.

ACKNOWLEDGEMENTS

I understand and agree that Salem reserves the right to make changes in program content, materials, or schedules as it deems necessary. Salem further reserves the right to discontinue my education, without notice, for unsatisfactory academic progress or attendance, non-payment of tuition or failure to comply with Salem’s policies and procedures.

I understand and agree that my tuition charges are for the right to attend classes in which I am enrolled and are in no way contingent upon my satisfactory academic progress, personal satisfaction, or attainment of employment upon graduation.

I have access to the academic catalog and have been informed of its availability on the University’s website for future reference.

I have read and understand both Page 1 and Page 2 of this Enrollment Agreement, and I acknowledge receipt of an exact copy of the same.

I understand and agree that this Agreement contains all the terms of my enrollment and acknowledge that no verbal statements have been made contrary to what is contained in this Agreement.

INSTITUTIONAL REFUND POLICY FOR UNITED STATES CITIZENS

In accordance with Salem policy, if a student is not accepted, all advanced money shall be refunded. If a student is accepted and then cancels registration before classes begin, all tuition paid in advance shall be refunded. Any student who begins classes on or after the start date of any semester and then completely withdraws prior to the end of any semester, Salem will earn tuition and fees based on the week in which the student withdraws and the student will be obligated on the following basis. If the last date of attendance is during the:

  • First calendar week of the semester, then an obligation of 25% of the semester’s tuition and fees.
  • Second calendar week of the semester, then an obligation of 50% of the semester’s tuition and fees.
  • Third calendar week of the semester, then an obligation of 75% of the semester’s tuition and fees.
  • Fourth calendar week of the semester, then an obligation of 100% of the semester’s tuition and fees.

Salem University determines the official date of a student’s withdrawal based on the student’s last date of attendance (LDA). The LDA is used to determine the amount of the refund that is due to the student. Salem’s refund procedure requires the Registrar to report official and unofficial withdrawals to the Financial Aid and the Bursar’s Offices. The Financial Aid Office is responsible for the review of student data and completion of the refund and repayment calculations as appropriate to institutional policy. The Student Accounts Office issues all refunds inclusive of refunds due to a student’s withdrawal from Salem. The payments of refunds due to withdrawal are processed within 45 days from the date of determination of withdrawal. The Financial Aid Office will contact student loan borrowers who withdraw from Salem and provide information and advising regarding loan repayment.

Salem will first calculate the amount of unearned Title IV assistance that must be returned to the federal student aid programs under the Federal Return of Title IV Aid policy. The unearned amount of Title IV funds will then be subtracted from the total amount of all funds that was paid for institutional charges the semester of withdrawal to compute the Adjusted Amount Paid. Salem will then calculate the amount of institutional charges (tuition and fees, etc.) that will be retained based on the requirements of any applicable state law or applicable institutional refund policies. The amount of institutional charges that can be retained will be subtracted from the Adjusted Amount Paid. If a credit balance from Title IV funds remains on the student’s account the refund will be made to the student or, with the student’s written authorization, to federal student aid programs in the order specified above in Federal Return of Title IV policy. If there is a non-Title IV credit balance the credit balance will be returned to the source of funding per agency policy and or to the student as permitted. The student will be billed for any outstanding charges.

The following refund policy applies to INDIANA residents attending Salem:

  1. A student is entitled to a full refund if one (1) or more of the following criteria are met:
    1. The student cancels the enrollment agreement or enrollment application within six (6) business days after signing.
    2. The student does not meet the school’s minimum admission requirements.
    3. The student’s enrollment was procured as a result of a misrepresentation in the written materials utilized by the school.
    4. If the student has not visited the school prior to enrollment, and, upon touring the school or attending the regularly scheduled orientation/classes, the student withdrew from the program within three (3) days.
  2. A student withdrawing from an instructional program, after starting the instructional program at the school and attending one (1) week or less, is entitled to a refund of ninety percent (90%) of the cost of the financial obligation, less an administrative fee of ten percent (10%) of the total tuition, not to exceed one hundred dollars ($100).
  3. A student withdrawing from an instructional program, after attending more than one (1) week but equal to or less than twenty-five percent (25%) of the duration of the instructional program, is entitled to a refund of seventy-five percent (75%) of the cost of the financial obligation, less an administrative fee of ten percent (10%) of the total tuition, not to exceed one hundred dollars ($100).
  4. A student withdrawing from an instructional program, after attending more than twenty-five percent (25%) but equal to or less than fifty percent (50%) of the duration of the instructional program, is entitled to a refund of fifty percent (50%) of the cost of the financial obligation, less an administrative fee of ten percent (10%) of the total tuition, not to exceed one hundred dollars ($100).
  5. A student withdrawing from an instructional program, after attending more than fifty percent (50%) but equal to or less than sixty percent (60%) of the duration of the instructional program, is entitled to a refund of forty percent (40%) of the cost of the financial obligation, less an administrative fee of ten percent (10%) of the total tuition, not to exceed one hundred dollars ($100).
  6. A student withdrawing from an institutional program, after attending more than sixty percent (60%) of the duration of the instructional program, is not entitled to a refund.

Adjustment of charges for INTERNATIONAL and DISTANCE EDUCATION students shall be governed by the policies published in Salem’s catalogs.

STUDENT COMPLAINT PROCESS

In order to provide an effective and equitable means of addressing student complaints, a process is available to any student who believes that Salem’s decision, action, or policy has unfairly and adversely affected his or her status, rights, or privileges as a student. In most cases, a complaint can be resolved at the campus level. Faculty and staff are available to guide students in completing their programs, and students must be aware of those resources and to whom issues and concerns should be addressed as follow:

Faculty: Resolution of academic concerns pertaining to individual courses such as grades, assignments, attendance, etc.

Department Chair or Program Director: Unresolved academic issues pertaining to the student’s program such as program objectives, curriculum, graduation requirements, licensure examinations, faculty, etc.

Academic Affairs Office: Unresolved issues pertaining to faculty, curriculum, grades, attendance, change of program, transfer of credit, graduation requirements, withdrawal, and personal issues which may impact the student’s education.

Office of the Registrar: Resolution of issues involving course scheduling and obtaining transcripts.

Financial Aid Office: Resolution of issues involving loans, grants, deferments, verification, federal funding, and consequences of withdrawal.

Bursar’s Office: Resolution of issues involving the status of the student’s account and issues of billing, such as monthly payments, etc.

Chancellor/President: Resolution of an issue in any area above that remains unresolved.

A student who believes that his or her complaint remains unsatisfactorily resolved by Salem may refer the complaint to the appropriate office below:

Accreditation: Accredited by the Higher Learning Commission, 230 South LaSalle Street, Suite 7-500, Chicago, IL 60604-1413 (www.hlcommission.org) 800.621.7440

NON-DISCRIMINATION AND EQUAL OPPORTUNITY

Salem is committed to the principles of non-discrimination equal opportunity. It is the policy of Salem not to discriminate on the basis of race, creed, sex, ancestry, color, religion, national origin, sexual orientation or disability with regard to its students, employees, or applicants for admission or employment. Such discrimination is also prohibited by federal law. Any complaint alleging failure of this institution to follow this policy should be brought to the attention of the University in writing.

Salem is authorized by the West Virginia Higher Education Policy Commission in accordance with the West Virginia Code of State Rules, Title 133, Series 20, Authorization of Degree Granting Institutions. The Commission can be contacted via http://www.wvhepc.edu or at 304.558.2101. Salem also is authorized by the Indiana Board for Proprietary Education, 101 West Ohio Street, Suite 300, Indianapolis, IN 46204-4206. The Board can be contacted via www.in.gov/bpe/ or at 317.232.1033.

Alcohol and Tobacco Policy

ALCOHOL POLICY

Salem University is primarily concerned with the health, safety, and well being of all students with respect to the intelligent use and non-use of alcohol. Salem University expects those who use alcohol to do so responsibly and within the bounds of the laws of the State of West Virginia and the City of Salem.

GENERAL STATE LAWS

Possession or consumption of alcoholic beverages, including beer, by anyone under the age of 21 is a violation of the West Virginia Alcohol Beverage Control Commission. It is also a violation of this same statue for anyone to buy for, or give to, anyone under the age of 21 to misrepresent his or her age, or who for such purpose presents or offers any written evidence of age which is false, fraudulent or not actually his or her own.

GENERAL LOCAL LAWS

With the City of Salem, it is a violation to be in possession of an open container of alcohol or to be in a state of intoxication on any public property or in any public place. It is also unlawful to drink any alcoholic liquor or beer in any motor vehicle or possess alcoholic liquor in an amount in excess of one gallon, in containers not bearing the stamps or seals of the West Virginia Liquor Control Commission.

UNIVERSITY POLICY

RESIDENCE HALLS STUDENTS and their invited guest who are 21 or older shall be allowed to possess and consume alcoholic beverages in their individual residence hall rooms and suites. If alcohol is being served or consumed the door to the residence’s room or suite must be closed at all times.

TOBACCO FREE POLICY

The use of any type of tobacco products (cigarettes, cigars, snuff, chewing tobacco, and so forth) is prohibited in any building on campus, including residence halls. This includes offices, lounges, cafeteria, gymnasium, elevators, stairs, classrooms, bathrooms, hallways, and all other interior spaces. Also, the use of any type of tobacco product is prohibited within the University’s fleet of vehicles.

The following agency is available to assist anyone in need of any confidential drug and alcohol counseling, treatment, or rehabilitation in the West Virginia are:

Summit Center for Human Development (Mental Health) (1-800-786-6480) Open 5 days a week

I have read and understand Salem University’s policy on alcohol and tobacco.

CATALOG ACKNOWLEDGMENT

I have reviewed the catalog during the interview and have been given the opportunity to familiarize myself with the information in the Salem International University catalog.

I understand that the Salem International University catalog is available to me online at www.Salemu.edu

Family Educational Rights and Privacy Act (FERPA)

The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student education records and gives students the right to authorize Salem University to release information from his or her records to other people or to outside agencies. Students may wish to have information released via electronic means, requiring a process by which the University can authenticate the identity of the person requesting the information. This form provides the means by which students may authorize the release of information to other parties and a means to authenticate his or her identity prior to the release of information to him or her. Refer to the Salem University FERPA Policy located in the University catalog or on the website (www.salemu.edu) for more information.

Talent Waiver

I hereby authorize Salem University to publish and exhibit likeness and understand that it may be used in advertising and promotional material for the school.

I understand that I shall receive no compensation for my appearance in any participation in the commercial.

I represent that I am at least 18 years of age and have the right to enter into this agreement. If I am under 18 years of age, my parent or guardian has consented to my execution of this consent.


Parent or Guardian Signature (if a minor)

High School Transcript Request Form


Please forward a copy of my transcripts to:
Salem University
Office of the Registrar
223 West Main Street
Salem, WV 26426

High School Graduate

High School Equivalent Certificate

Certification

I certify that I have graduated from the high school indicated above, or have received the High School Equivalent Certificate indicated above. I request that a copy of the transcript or High School Equivalent Certificate be forwarded to Salem University at the address above.

Official transcripts of all undergraduate and graduate programs sent directly to Salem University Registrar’s Office from the Registrars’ Office of each college previously attended.

International Student’s Only

Applicant’s whose degree was taken in a language other than English must submit a certified true copy of the transcript in English translation and a certified true copy of the transcript in the original language.

Please return this form, or a copy of it, with my transcript or GED scored to assist in identification of my file.



ENROLLMENT AGREEMENT ADDENDUM
BACHELOR OF SCIENCE IN NURSING
(RN-to-BSN DEGREE-COMPLETION PROGRAM)

Understand and agree that I am applying to Salem’s Bachelor of Science in Nursing (“BSN”) of my own free will. I understand and agree that the BSN is a degree-completion program strictly limited to registered professional nurses holding unencumbered RN licenses that are valid in the United States. I understand and agree that my progression in the BSN is contingent upon my continuing to meet all of the admissions and academic requirements stated in the University’s current catalog, as amended from time to time, for the duration of my studies. I understand and agree that I must meet all of the criteria listed below, signaling my explicit agreement by initialing each blank

I understand and agree that the BSN requires successful completion of 120 semester credit hours including at least 30 credit hours completed at Salem; and I must achieve a cumulative grade-point average (“GPA”) of at least 2.5 for all courses taken at Salem and grades of “C” or higher in the Core, comprising NUR401, 402, 403, 404, 405, 406, 407, 408, 410, and 499.

I understand and agree that by enrolling in one three-credit course of four weeks’ duration, my studies will require sustained effort comparable to a full-time job.

I understand and agree to abide by the Student Code of Conduct and the School of Nursing Social Media Code of Conduct, copies of which have been provided to me, and furthermore that, if I fail to do so, I am subject to academic or administrative sanctions up to and including dismissal.

I understand and agree that the Salem BSN program has been approved by the Higher Learning Commission, located at 230 South LaSalle Street, Suite 7-500, Chicago, IL 60604, 800.621.7440, http://www.hlcommission.org; that the BSN program has achieved pre-accreditation candidacy status with the National League for Nursing Commission for Nursing Education Accreditation (CNEA), located at 2600 Virginia Avenue, NW, Washington, DC, 20037, http://www.nln.org/accreditation-services/overview, 800.669.1656; and that holding pre-accreditation candidacy status does not guarantee initial accreditation by CNEA will be received.

I understand and agree that Salem’s College Affordability Initiative tuition of $250 per credit or $750 per three-credit course does not include course materials and is offered only for a limited time, not to exceed 24 months from the date of my first enrollment in the BSN.

I understand and agree that this Enrollment Agreement Addendum is binding and that all of the terms and conditions of my Enrollment Agreement, including arbitration, which I already have signed and filed with Salem, apply fully to this Enrollment Agreement Addendum and are incorporated herein in their entirety.

ENROLLMENT AGREEMENT ADDENDUM
ASSOCIATE DEGREE IN NURSING

Understand and agree that I am being accepted a pre-nursing student at Salem University (Salem). I understand and agree that consideration for acceptance into the nursing core courses (NUR-prefix courses) in the Associate Degree in Nursing (ADN) Program is contingent upon continuing to meet all the admissions and academic requirements as stated in the University catalog and the ADN Handbook. In addition, I understand and agree that I must meet and am subject to all of the necessary criteria listed bellow, signaling my agreement by initialing each black:

I understand and agree that I will be considered a pre-nursing student major until accepted into the nursing core courses, at which time I will be considered a nursing student major.

I understand and agree that acceptance into the nursing core courses is competitive, and there is no guarantee that any pre-nursing student Will progress to the nursing core courses.

I understand and agree that to be considered for admission to the nursing core courses I must successfully complete all required prerequisite general education courses with a grade of "C" or higher.

I understand and agree that to be considered for admission to the nursing core courses I must earn a cumulative GPA of 3.0 or better form all college lever courses.

I understand and agree that to be considered for admission to the nursing core courses, I must archive a TEAS composite score of 60 with a minimum of 50 on each subset and that I may only take the TEAS twice per semester.

I understand and agree that, if I was previously enrolled in the ADN program, I nevertheless will have no preferred status and will have to meet the current admissions and academic requirements and other terms and conditions as applicable.

I understand and agree that the WV Board of Examiners for registered professional Nurses regulates the number of nursing students admitted to nursing programs.

I understand and agree that de Salem nursing program may have more pre-nursing students majors who quality for acceptance into the nursing core courses that there are slots available, which may result in having to sit out for a period of time.

I understand and agree that Nursing gives priority for acceptance to the nursing core courses to the most qualified students, taking into account highest academic stating, best TEAS score, and other relevant predictors of success int the program and of passing the NCLEX-RN.

I understand and agree that if I compete in intercollegiate athletics during my first year while completing the general education courses, I will not compete in athletics during my second year while completing the NUR courses in the nursing program.

I understand and agree that if I do not earn a 3.0 cumulative GPA in the pre-nursing (general education) courses, and pass the TEAS after my first year, I will not qualify to begin the second year NUR courses, and will be required to change my major.

I understand and agree that if I do not pass the NCLEX-RN after muy second year, I will not qualify to begin the third year BSN courses, and will be required to change my major.

I understand and agree that students who are accepted info the nursing core courses as nursing students will have a workload equivalent to a full-time job and that I will not be excused from class for work and, furthermore, that my absences will be handled according to the ADN Handbook, which may lead to dismissal from the program.

I understand and agree that my admission to Salem University and to the School of Nursing must conform with the University and the School of Nursing policies and procedures, catalogs, and the ADN Handbook, current of future.

I understand and agree that this Agreement is binding and that the terms and conditions of my Enrollment Agreement, already signed and filed with Salem, apply fully to this Agreement and is incorporated in its entirety herein.

ENROLLMENT AGREEMENT ADDENDUM
MASTER OF SCIENCE IN NURSING (MSN)

, understand and agree that I am applying to Salem's Master of Science in Nursing(MSN) program of my own free will. I understand and agree that this MSN program is strictly limited to registered professional nurses holding an unencumbered RN license that is valid in the United States, and that I must maintain that licensure throughout the program of study. I understand and agree that I must hold a bachelor's degree in nursing from an accredited institution with a cumulative GPA of at lest 2.5 on a 4.0 scale for admission to the MSN program. I understand and agree that my progression in the MSN program is contingent upon my continuing to meet all of the admissions and academic requirements stated in the University's current catalog and the MSN Handbook, as amended from time to time, for the duration of my studies.

I understand and agree that I must meet, and am subject to all of the criteria listed bellow, signaling my explicit agreement by initialing each black:

I understand and the agree that the MSN requires the successful completion of 30 graduated credit hours comprising 10 courses completed at Salem, with a cumulative GPA of a least 3.0 and with grades of "C" or higher.

I understand and agree that the MSN requires the successful completion of the core content consisting of 18 credit hours (6 courses) and an additional 12 credits hours (4 courses) of my chosen specialization in nursing administration or nursing education.

I understand and agree that by enrolling in one three-credit courses of four weeks' duration, my studies will require a sustained effort comparable to a full-time job.

I understand and agree to abide by polices of the University and the School of Nursing, including the Student code of Conduct and the School of Nursing Social Media Code of Conduct, copies of which have been provided to me; and furthermore that, if I fail to do so, I am subject to academic or administrative sanctions up to and including dismissal.

I understand and agree that Salem University, witch includes the MSN program, is accredited by the Higher Learning Commission, located at 230 South LaSalle Street, Suite 7-500, Chicago, IL 60604, 800.621.7440, http://www.hlcommission.org.

I understand and agree that Salem’s tuition is $650 per credit or $1950 per three-credit hours plus $100 technology fee per semester and $100 Book free per course

I understand and agree that this Enrollment Agreement Addendum is binding and that all of the terms and conditions of my Enrollment Agreement, including ARBITRATION, which I already have signed and filed with Salem, apply fully to the Enrollment Agreement Addendum and are incorporated herein in their entirety.

School of Education Graduate Application

Program

Applicant Information

Enrollment Information

Educational History:

List all colleges or universities you have attended. Send ONE OFFICIAL TRANSCRIPT from any institution that awarded your Bachelor’s and/or Master’s degree. If you would like consideration for graduate transfer credit, include an official transcript from each institution. Applications are not considered without necessary transcripts. Transfer credit is not awarded without official transcripts.

Name of Institution Dates of Attendance Degree Academic Major GPA Graduation Date

Professional Experience

Please list all professional education experience. Include ONLY positions that required a state issued educational license and were full-time, contracted assignments. DO NOT INCLUDE SUBSTITUTE TEACHING experience. In the rare event you have been awarded full-time experience for a long-term substitute position by your school district, please make note of this. (Any such situations will have to be verified to and approved by the Dean of Education through documentation letters provided by the student’s school district.)

School and/or School Division Dates of Employment Position Type of License Required Years of Full-Time, Contracted Experience

Financial Aid Assistance Information:

Registration:

In accordance with my Enrollment Agreement I am registering to take classes and wish to take the following number of credit hours over the next 4 months: (please circle)

Dean signature

College Transcript Request

I certify that I have attended college as indicated below.

IMPORTANT: Use a separate form for each college or university previously attended.

I hereby authorize the release of my official transcript to:

Salem University
Office of the Registrar
223 W Main St
Salem, WV 26426



Disclosure of Education

TO: All Students Salem International University generally will not permit disclosure of personally identifiable information from the records of a student without prior written prior written consent of the student. Personally identifiable information is disclosed (some items are mandatory, some discretionary) form the records of a student without that student’s prior written consent to the following individuals or institutions or in the following circumstances:

  1. To Salem International University officials who have been determined by the school to have legitimate educational interests in the records, A School official is:
    1. a person employed by the school in an administrative, supervisory, academic or research, or support staff position; or
    2. a person employed by or under contract to the school or perform specific tasks, such as an auditor, consultant, or attorney, a person on the Board of Trustees, or a student serving on an official committee or assisting another school official.
      Any school official who needs information about a student in the course of performing instructional, supervisory, advisory, or administrative duties for Salem International University has a legitimate educational interest.
  2. To certain officials of the United State Department of Education, the Comptroller General of the United States, the Attorney General of the United States, and state and local educational authorities in connection with the state or federally supported educational programs.
  3. In connection with the student’s request for, or receipt of, financial aid necessary to determine the eligibility, amounts or conditions of financial aid, or to enforce the terms and conditions of the aid.
  4. To organizations conducting certain studies for or on behalf of the school.
  5. To accrediting commissions or state licensing or regulatory bodies to carry out their functions.
  6. To parents of a dependent student, as defined in Section 152 of the Internal Revenue Code.
  7. To comply with a judicial order or lawfully issued subpoena.
  8. To appropriate parties in health or safety emergencies.
  9. To an alleged victim of a crime of violence or non-forcible sexual offense, the final results of disciplinary proceedings conducted by the school against the alleged perpetrator of that crime or offense with respect to that crime or offense.
  10. Topersonsinadditiontothevictimofacrimeofviolenceornon-forciblesexualoffense,thefinal results of the disciplinary proceedings described in paragraph 9 above but only if the school has determined that a student is the perpetrator of a crime of violence or non-forcible sexual offense, and with respect to the allegation made against him or her, the student has committed a violation of the institution’s rules or policies. (The school, in such instances, may only disclose the name of the perpetrator- not the name of any other student, including a victim or witness- without the prior written consent of the other student(s).
  11. To a parent regarding the student’s violation of any federal, state, or local law or of any rules or policy of the school governing the use or possession of alcohol or a controlled substance if the school determines that the student has committed a disciplinary violation with respect to that use or possession, and the student is under 21 at the time of the disclosure to the parent.
  12. DirectoryInformation

E-Mail and Computer Use Policy

To maximize the benefits of its computer resources and minimize potential liability, Salem International University has created this policy with regard to computer use and electronic messages. It applies to all University personnel and students. The university reserves the right to change this policy at any time as may be required under the circumstances. All computer users are obligated to use these resources responsibly, professionally, ethically and lawfully.

You are given access to our computer network to assist you in performing your job or completing your academic tasks. You should not have an expectation of privacy in anything you create, store, send or receive on the computer system. The computer system belongs to Salem International University and may only be used for business or academic purposes. Without prior notice, the University may review any material created, stored, sent or received on its network or through the internet or any other computer network. The University can restrict access to any services and / or material that travels across its network at any time without prior notification.

Use of computer resources for any of the following activities is strictly prohibited.

  • Allowing any other person or person to access your account
  • Attempting to circumvent or alter any access control or security measure on local or remote systems or to create an exploitable entry point of unauthorized persons with or without intent.
  • Sending, receiving, creating, storing or otherwise disseminating material that is offensive or disruptive. Among those which are considered offensive are any messages that are sexually explicit, profane, obscene, harassing, fraudulent, racially offensive, and defamatory or otherwise offensively address someone’s age, sexual orientation, religious or political beliefs, national origin or disability.
  • Wasting computer resources by, among other things, sending mass mailing or chain letters, spending excessive amounts of time on the internet, play games, enraging online chat groups, printing multiple copies of documents, printing excessively long Internet documents or otherwise creating unnecessary created network traffic.
  • Downloading, sharing or using software or media in violation of license agreement or copyright.
  • Violating any state, federal or international law.
  • File sharing utilities on the University network will not be tolerated.

If you become aware of someone using computer resources for any of these activities, you are obligated to report the incident immediately to your supervisor or the chief Information Officer. Violations of this policy will be taken seriously and may result in disciplinary action, including possible employment termination or university expulsion, as well as civil and criminal liability.

The confidentiality of any message should not be assumed. Even when a message is erased, it is still possible to retrieve and read the message.

I have read and agree to the terms of this policy.

Signature

Technician Use Only:

Technology Policy

In an effort to assist students with adequate preparation for their course work at Salem University, we prescribe certain minimum technology specifications for our online students. The guidelines are important, as we deem having access to adequate technology is critical to success as an online student.

If you have access to technology that meets these thresholds, please indicate that by acknowledging and signing this document. As with any admissions document, any willful or intentional misrepresentation may lead to dismissal from the university.

To that end, students will need to access and use the hardware and software as described below. Additional recommendations and competencies may be required for particular courses/programs. Students using software and hardware other than that recommended must still meet the technology competencies. Please note that due to the rapid rate of change in information technology, hardware and software competencies will be updated on a regular basis. Some courses in the College of Information Systems and Technology may require additional software.

Minimum Technology Guidelines

You must have reliable access to a personal computer or have direct and consistent access that meets the following specifications:

  • A processor of 1.2 GHz or faster
  • 4 GB RAM or greater
  • A high speed internet connection with a connection speed of 1.5 MB/s or better.
  • The use of satellite and cellular connections may result in slowness or errors (timeouts, access problems) when accessing the classroom and course materials.
  • Monitor and video card with 1024x768 or greater resolution
  • Keyboard and Mouse is recommended
  • The ability to run the latest version of a web browser such as Google Chrome