Shaw University

1
Shaw University
Department of Social Sciences Social Work Program
New Student Profile
Social Work faculty, please ensure that student
completes this form when enrolling as a Social
Work major. This form must be returned to the
Program Administrative Assistant.
Students Full Name _____________________________
________________________
Raleigh Day
CAPE __________________________
ID _______________________________ PIN
___________________________ Male _____ Female
_____ Date of
Birth ____________________ Person With
Disability Yes No (If yes, please
explain) ___________________ _____________________
_________________________________________________
Current Address Address ________________________
___________________________________ City
______________________________ State _____
Zip _________________ Telephone
__________________________ Mobile
________________________ Permanent
Address Address ________________________________
___________________________ City
______________________________ State _____ Zip
_________________ Telephone _____________________
_____ Mobile ________________________
Place an x beside the group that you most
identify with.
African American/Other Black ___ American
Indian/Native American ___ Asian American
___ Chicano/Mexican American ___ Puerto Rican
___ Other Latino/Hispanic ___ Pacific Islander
___ White (non-Hispanic) ___ Multiple
Race/Ethnicity ___ Foreign (no resident visa)
___ Other ________________________ Unknown
______________________
More details on reverse side
Revised June 12, 2008
Proponent Social Work Program
2
New Student
Change of Major Student Yes
No (If yes, what was your previous major?)
______________________________________
Change of Major Form Completed Yes
No (If yes, attach copy of form) Transfer
Student
Yes No (If yes, fill out the appropriate
information listed below)
Did you transfer to Shaw University from one of
the following? (Please indicate) NC
Community/Junior College Name
_________________________________ NC Public
Four Year Institution
Name _________________________________ NC
Private Four Year Institution
Name _________________________________
Out-of-state Two Year Institution
Name _________________________________
Out-of-State Four Year Institution
Name _________________________________
Unknown __________________
Name _________________________________ Are you
a full-time student (taking 12 or more credit
hours a semester)? Yes No Are
you a part-time student (taking less than 12
credit hours a semester)? Yes No
Students Signature ___________________________
Date _________________ Advisors Signature
___________________________ Date
_________________
Comments _______________________________________
____________ _____________________________________
_________________________ ________________________
______________________________________