Intent to Enroll and Statement

Science in the Evening (SIE) Spring 2021
Post-Baccalaureate Program Application

  • If further information is required, you will be contacted via email. Upon review, official notification will be sent via email.
  • A Bachelor's Degree is required. If you do not have a Bachelor's Degree, the form will allow a printed version to be generated for special consideration.
  • The non-refundable $75.00 application fee is required at the time of application submission.

Student Information

U.S. Social Security Number

*Leave blank if you do not have a SSN. You will be issued a university student identification number.
Professional/Graduate School are you interested in attending?
*United States Citizen?


*Student Name


Middle Name

* Email address:
* Gender
Male Female
* Date of Birth:
- Year:

Permanent Mailing Address

Postal Code:
Home phone number:
Daytime/Mobile phone number:

Race and Ethnicity Data Collection

Colleges and universities are asked by many, including federal and State governments and national surveys to describe the racial/ethnic backgrounds of our students and employees. You should answer both questions.
Are you of Hispanic or Latino origin? Yes No
What is your race? Select one or more of the following categories. Select one or more of the following categories.
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Education Information

Have you ever previously applied for admission to the University of Maryland, College Park?
Please enter your college information below
State City School

Judicial Information

The University is committed to providing equal educational opportunities. The University also strives to ensure a safe campus and learning environment. Therefore, while the University asks questions about disciplinary and criminal history, a positive answer to these questions does not automatically disqualify an applicant for admission. In the admission process, applications are reviewed for academic eligibility without consideration of whether the applicant answered yes to any of these questions. After an applicant is determined to be academically eligible, a separate review of disciplinary history is conducted prior to a final determination on admission. All relevant circumstances will be considered. The University reserves the right to request further information from the applicant to verify the information disclosed. In addition, applicants who are admitted may be required, as a condition of participation in certain programs, to complete a criminal history consent form, and agree to a criminal background check. When answering the questions below, please note that you are not required to report information related to minor traffic violations or records that have been expunged.

Please note: You are required to update the Office of Extended Studies at (please use the subject line "Disciplinary Update") should a situation take place that would cause your answer to one of the below questions to change. This includes, but is not limited to, any criminal convictions or disciplinary actions taken against you after the time of application submission through the start of classes of your first semester at the University.
*Have you ever been convicted of a crime?
*Do you have criminal charges pending against you?
*Have you ever had disciplinary action (academic or non-academic) taken against you at any educational institutions you have attended?
*Have you ever had disciplinary action taken against you by any branch of the military?
*Do you have a restraining order pending against you?

Additional Questions

Are you a U.S. armed forces veteran? Please note: This program is not eligible for VA Benefits.
*Do you wish to be considered for in-state tuition status?
Click here for the Policy on Student Residency Classification.

I certify that I have earned a four-year baccalaureate degree with at least a 2.0 grade point average (on a 4.0 scale). I understand official transcripts must be submitted for admission to the Science in the Evening (SIE). I certify that all information provided on this application is complete and correct. If it is not, I understand that cancellation of admission and registration may result. I agree to abide by the rules, policies and regulations of the University of Maryland. I agree to pay the $75.00 non-refundable application fee which will be assessed regardless of my decision to register. If I am a state of Maryland resident, I must complete the Maryland Residency Classification Information Form. I have read the SIE Web site, found at and understand the registration requirements including the online Math Placement Test (MPT), advising, Medical History & Immunization Record form, SIE Enrollment Policy, as well as the tuition, fees, and payment due information. I understand that upon registration for courses, it is my responsibility to ensure that payment posts to my student account by the SIE payment due dates or risk cancellation and loss of course access and seat(s).

* Signature (name) of applicant for program:
*Date: - Year:

If you have any comments or questions please email:

Office of Extended Studies
University of Maryland
Office of Extended Studies
Suite 0132
Main Administration Building
7901 Regents Drive
College Park MD 20742