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1. Date (EX: 07/04/2003)
2. *Social Security No.
*SSN is optional for admission; required for financial aid or if you plan to take advantage of educational tax credit/incentives. Solicited per K.S.A. 76-725. Used as student identifier for records and accounts. In the admissions and scholarship selection process, the SSN is used to assist in matching test scores and credentials of applicants.
3. First Name:
4. Middle Name:
5. Last Name:
6. Other names under which your records might be
found:
7. Mailing Address:
8. City:
9. State:
10. Zip Code:
11. County (NOT COUNTRY)
12. Home telephone no.
13. Work telephone no.
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14. E-mail address:
15. Permanent Address (if different):
16. Semester in which you anticipate
enrolling:
Fall 2009 Spring 2010
Summer 2010
Fall 2010 Spring 2011 Summer 2011
17. Optional. These questions will be used only
to the advantage of the applicant.
Gender: Male Female
I am Hispanic/Latino: Yes No
I am (please choose one or more): American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Date of Birth (EX: 07/04/2003):
18. Are you a citizen of the United States? Yes No
If no, list country of birth:
City:
Province/State:
Visa type:
Are you a permanent resident?
Are you an exchange student?
19. Are you a Kansas resident (lived in Kansas for the last 12 months)? Yes No
20. Please select your objective for enrolling from one of the choices below. PLEASE MAKE ONLY ONE SELECTION FROM THE OPTIONS BELOW. If you are applying to both a degree program and licensure, you must complete two separate applications.
Graduate Degree Sought:
OR
Licensure Program Sought:
OR
Certificate Program Sought:
21. If you selected MBA as your graduate degree sought in question #20, will you be taking your coursework at the Metro Learning Center in Kansas City? Yes No
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