List the last high school and all colleges and universities you have attended. Required: Failure to submit official required information may result in dismissal from the University.
State of Arkansas
Statement of Selective Service Status
In Compliance with ACT 228 of the 1997 Acts of the Arkansas General Assembly
I understand that to be eligible for admission to Henderson State University, I must register, or be exempt from registration, with the Selective Service System in accordance with the Military Selective Service Act 50 U.S.C. Appx. 451 et seq., as specified in Act 228 of the 1997 Acts of the Arkansas General Assembly. I therefore swear or affirm under penalty of perjury that I have registered with the Selective Service System, or I am exempted from such registration because of the following provision(s) of the Military Selective Services Act 228 of the 1997 Acts of the Arkansas General Assembly.
If Other, please specify:
I understand and agree that during my tenure as a student at Henderson State University, I am responsible for paying when due all charges associated with enrollment and attendance at Henderson.
I have read and understand all of the information on this application form and the information I have provided is factually correct and honestly prepared.
By submitting this information to Henderson State University you are agreeing to the above statement.
The campus coordinator for the Americans with Disabilities Act and Sec 504 of the Rehabilitation Act is the Executive Assistant to the President, HSU Box 7744.
It is the policy of Henderson State University not to discriminate on the basis of race, color, national or ethnic origin, sex, marital or veteran status, age or disability. Henderson works continually to assure compliance with applicable federal laws, including among other, the Civil Rights Acts; the Education Amendments, the Rehabilitation Act; the Americans With Disabilities Act, the Family Educational Rights and Privacy Act; the Student Right to Know Act; the Campus Security Act; and the Drug-Free Schools and Communities Act.
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