STUDENT INFORMATION

Student's First Name*

Student's Last Name*

Student's Street Address*

Student's City, State, and Zip Code*

Student's Email Address*

Student's Phone Number*

Student's Date of Birth*

Student's Assigned Gender at Birth (for housing purposes)*

Male

Female

Student's Grade NEXT School Year (2025-2026)*

Sophomore (10th)

Junior (11th)

Senior (12th)

Student's High School*

Student's T-Shirt Size*

PREVIOUS ATTENDANCE

I have previously attended the Joseph Baldwin Academy at Truman State University - please mark all that apply.

2024

2023

2022

2021

Never Attended

I have previously attended the ATSU-Truman Healthcare Academy. Please mark all that apply.

2023

2022

Never Attended

SERVICE / AWARDS / HONORS

Please list your most important community, school, and/or work activities in which you have participated, including the year(s) you were involved. (examples: Boy Scouts/Girl Scouts 2010-2015, Student Council President 2021, Student Council Member 2018-2020, Food Pantry Volunteer 2018-2021, etc.) If none, type "none".*

Please list any special honors or awards you have received in your school and/or your community during the past three to five years. (examples: Boy Scouts Eagle Merit Badge, National Merit Award, Honor Roll, etc.) If none, type "none".*

ESSAY

Essay Response:

Please read ALL of the following information provided before attaching your essay file below.
Academy faculty admit students to the ATSU-Truman Healthcare Academy based on several criteria, including their response to the following essay.
We recommend that you write your 1-3 page essay on a personal device and upload it as a PDF below.

Please respond to the following prompt:
Why do you want to attend the ATSU-Truman Healthcare Academy and how will it benefit your future?

*

Any information you want to include for your application. This space is completely optional.

PARENT INFORMATION

Parent/Guardian #1 Name (First and Last)*

Parent/Guardian #1 Address (if different than student's), otherwise enter "same"*

Parent/Guardian #1 Email Address*

Parent/Guardian #1 Cell Phone Number*

Parent/Guardian #2 Name (First and Last)

Parent/Guardian #2 Address (if different than student's), otherwise enter "same"

Parent/Guardian #2 Email Address

Parent/Guardian #2 Cell Phone Number

REFERENCE INFORMATION

Reference:

Please provide the name and title of a teacher, counselor, or administrator (from this year or the previous school year) who is familiar with you and can serve as a reference. (example: Mr. Smith, Mrs. Jones, Dr. Brown) *

Reference:

Please provide a complete and current email address for your chosen reference. When you submit your application, the person you list will be sent a recommendation form to complete. *

TRANSCRIPTS

Transcripts:

Please submit your 2023-2024 transcripts and first semester of 2024-2025 grape card/report.

Transcripts/grades can be uploaded below, emailed, mailed, or faxed to the ATSU-Truman Healthcare Academy.

Email: hca@truman.edu

Mail:

Truman State University
Institute for Academic Outreach
ATSU-Truman Healthcare Academy
100 East Normal Avenue
Kirksville, MO 63501

Fax: 660-785-7202

DIGITAL SIGNATURE

By typing my name, I understand and agree that this form of electronic signature will be the same as if I had provided my manual signature to submit this application for admission to the ATSU-Truman Healthcare Academy.*