Ship Start Application

Ship Start Round Selector

PIN Generation

Yes

No

App Submitted Flag

New App Always

Personal Info

First (Legal) Name

Last

Would you like to share a different first name that you go by?

Yes

No

My First Name

Birthdate

Email

Cell Phone

May we text you?

Yes

No

Mailing Address

Country

Street

City

Region

Postal Code

Sex

Primary Citizenship

Social Security Number (omit dashes)

U.S. Permanent Resident?

Yes

No

Are you Hispanic or Latino?

Yes

No

Please check one or more of the following groups in which you consider yourself to be a member:

Are you a current Pennsylvania resident who has lived in the state for more than 12 months?

Yes

No

Ship Start Info

Which type of student you will be:

Ship Start

When do you plan to start taking Ship Start classes?

What grade are you currently in?

Program

Do you plan to apply to Shippensburg University to pursue your degree?

Yes

No

Which courses are you intending to take?

A variety of classes on-campus.

I am interested in Psych 101 online.

Just Psych 101 online (for students more than 35 miles from campus).

I am interested in other online courses.

Parent/ Guardian Information

Parent/Guardian

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Mailing Address

Country

Street

City

Region

Postal Code

Are you a child of a Shippensburg University employee?

Yes

No

What is the name of your parent who is employed at Shippensburg University?

School Info

High School Name

CEEB Code

Level of Study

Lookup your school name by the location first.

Start Date

Expected Graduation Date

Have you taken the PSAT, SAT, or ACT as of today? (It's ok if you haven't!)

Yes

No

Signature

FERPA RELEASE: As a participant in the Ship Start program, I give my permission to release my educational records to my current high school including a transcript/grade report, disciplinary records and scheduling information. The information will be released for the following purposes: high school class scheduling, inclusion on the high school transcript, awarding of credits, and determining continuation in the Ship Start program. I understand the information will be released orally and in written records. I have the right to inspect any written records released (exceptions: parents’ financial records and certain letters of recommendation). I understand I may revoke this consent at any time.

Today's Date

In place of signature, please type your full name: