Valparaiso University
1700 Chapel Dr
Valparaiso, IN 46383
1-888-GO-VALPO
Email

Common Application Supplement

Thank you for submitting an application to Valparaiso University. There is some information not requested on the Common Application that would be very helpful to have as part of your application. Please complete this form and return it to the Admissions Office.

Name and contact

First name
Last name
Street address
City

– – Phone #
– – Alternate Phone #
Email

Religious

Church denomination
Lutheran affiliation, if applicable
Pastor's Name
Church name
Church street address

Do you have a parent who is a full-time rostered professional Lutheran church worker? Yes No
Parent name

Valpo heritage

List the names and relationships of your relatives who have attended or are now attending Valparaiso University

Name
Relationship
Years attended

Name
Relationship
Years attended

Family

Please list the names of your siblings and their high school graduation

Name
High school
Graduation year

Name
High school
Graduation year

Other factors

What factors most influenced your decision to apply for admission to Valparaiso University?

Please list any other colleges to which you are applying.

Required to complete your application

Have you ever been dismissed, placed on probation, or suspended from school? Yes No

Have you ever been convicted of a crime other than a minor traffic offense? Includes offenses removed from your record. Yes No

If any of the above information changes after you have submitted this form, you must notify us as soon as possible.

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