FUNERAL SCIENCE PROGRAM APPLICATION

Complete the application below to apply to the ASU- Mountain Home Funeral Science program. Required uploads (transcripts and volunteer/job-shadowing documenation) must be attached before submitting.

* First Name

* Middle Name

* Last Name

* Phone

* ASUMH Email

* Address

* City

* State

* Zip

Prerequisites

* Upload transcripts from all previously attended colleges/universities showing final grades and CGPA, and/or a copy of your course schedule showing enrollment in the required class(es) with the instructor’s name and email.

BIOL 1013 Introduction to Human Anatomy and Physiology for Non-Healthcare Majors

OR take BOTH BIOL 2004 and BIOL 2014 below

Final Grade

Mid-Term Grade

BIOL 2004 Human Anatomy and Physiology I & Lab

Final Grade

Mid-Term Grade

BIOL 2014 Human Anatomy and Physiology II & Lab

Final Grade

Mid-Term Grade

CIS 1053 Computer Essentials

Final Grade

Mid-Term Grade

COMM 1203 Oral Communication

Final Grade

Mid-Term Grade

ENG 1003 Composition I

Final Grade

Mid-Term Grade

MATH 1113 Applied Math or higher-level math

Final Grade

Mid-Term Grade

ORT 1001 First Year Experience for Funeral Science

Final Grade

Mid-Term Grade

Admission acceptance status made at the application due date is contingent on final grades.

* Upload volunteer / job-shadowing documentation — documentation of 20 hours of volunteer/job shadowing in the funeral service industry.

Upload Affiliation Agreement (recommended but not required).

Additional Certifications / Experience — list any additional certifications or experiences that you feel will benefit you in the funeral service industry.

Important Disclosures

Please initial and date each statement below to acknowledge you understand it.

I understand the program has a specific course rotation that I am required to follow each semester.

* Initials

* Date

I understand that all Funeral Science Education curriculum course work must be completed with a grade of “C” or better.

* Initials

* Date

I understand that I must maintain a 2.5 GPA and will only be allowed to retake courses from which I withdrew or failed in the first semester upon admission to the program.

* Initials

* Date

I understand that I am responsible for any costs associated with the program, including field trips and any required visits to the Mountain Home campus.

* Initials

* Date

I understand that it is my responsibility to know the licensing requirements for any state in which I intend to practice.

* Initials

* Date

I understand that students who have previously been convicted of a crime may be restricted from certain clinical facilities and may be ineligible for some state licenses.

* Initials

* Date

I understand that students who have a physical disability should contact the state in which he/she plans to seek licensure to determine if the disability will affect licensure.

* Initials

* Date

I understand that a current driver’s license is required prior to enrolling in a clinical or practicum course.

* Initials

* Date

I have read and understand the program dismissal policies contained within the Funeral Science Student Handbook.

* Initials

* Date

I have read the Funeral Science Student Handbook, specifically the academic expectations, dress and hygiene codes and other student requirements, with which I will comply. I further understand that there may be costs involved for these requirements. I understand that misrepresenting and/or falsifying any information submitted within this application will result in my immediate termination for consideration within the Funeral Science program.

* Signature

* Date