Information about http://www.callutheran.edu/adep/documents/ADEP_Application_2006.pdf
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Tags: adep, admission, applicationform, e mail, middle maiden, personal data, state zipcode,Pages: 2
Language: english
Created: Mon Jul 24 15:15:10 2006
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ADEP-AdultDegreeEveningProgram
ApplicationForm
I.D.#_________________________________
Qualifications for Admission Comp Incomplete
· 25yearsofage · Full-timeworkexperience AdmissionStatus________________________
· 12transferablecollegesemestercredits · $50applicationfee DateAdmitted__________________________
· 2.25cumulativegradepointaverage ApplicationFee_________________________
Major_________________________________
Please Print or tyPe
For clu use
PersonAl DAtA
Name ________________________________________________________________________________ ________________________________
_
Last First Middle Maiden (Pleaselistanyotherlastnamesyouhaveused.)
HomeAddress__________________________________________________________________ E-mail___________________________________
NumberandStreet
____________________________________________________________________________________________________________
City State ZipCode
HomePhone( __________ )________________________________
_ BusinessPhone(___________ )_________________________________
Employer___________________________________________________________ CurrentOccupation__________________________________
Employer'sAddress ______________________________________________________________ E-mail___________________________________
NumberandStreet
________________________________________________________________________________________________________
City State ZipCode
DateofBirth_______________________________________________ PlaceofBirth________________________________________________
SocialSecurityNumber ___________________________________________ CountryofCitizenship____________________________________
DoyouholdacurrentVisaforentryintotheU.S.?Yes No N/A
Ifyes,pleaseindictetypeandexp.date:_________________________________________________________________________________________
IfnotaU.S.citizen,areyouaU.S.permanentresident?Yes NoAlienReg.# __________________________________________
eDucAtion PlAns
Degree Formajorin _____________________________________________________________________________
_
Non-Degree/ITorISCertificate
Non-Degree/SpecialStatus
Termofentry: FallTerm SpringTerm WinterTerm SummerTermYear___________________________________
tuition
Doyouplantoapplyforfinancialaid? Yes No(certificate students are not eligible for financial aid.)
AreyoueligibleforVeteran'sBenefits? Yes NoDoesyourcurrentplaceofemploymenthaveatuitionreimbursementplan? Yes No
Previous eDucAtion
Pleaselist in reverse chronological orderallcollegesattendedandtheapproximatenumberofcreditsearnedateach.
Remembertorequestofficialtranscriptsfromeachinstitutionattended.(SeeTranscriptRequestForms.)
School Location DatesAttended Degreesor#ofCreditsEarned
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
HaveyoupreviouslyappliedforadmissiontoCaliforniaLutheranUniversity? Yes No
Haveyoueverbeenplacedonacademicprobationorbeenacademicallydisqualifiedfromacollegeoruniversity? Yes No
Ifyouansweredyes,pleaseexplainthecircumstances:______________________________________________________________________________
________________________________________________________________________________________________________________________
(over)
suPPlementAry Questions
HowdidyoufirstlearnaboutCLU'sAdultDegreeProgram?
PersonalReferral Newspaper(specify) ______________________________________
Employer Radio(specify) __________________________________________
Flier Other(specify) __________________________________________
Optional Section
Sex: M F MaritalStatus _________________________________________________________________
ReligiousAffiliation __________________________________ IfLutheran,whichsynod?__________________________________
_
EthnicBackground(checkone)
AmericanIndianorAlaskanNative Hispanic
AsianAmerican Caucasian
AfricanAmerican Other
ProvisionAl ADmission Agreement
I,____________________________________________ ,assureCaliforniaLutheranUniversitythatIhavecompletedatleast12units
ofcollegeworkwhichareacceptablefortransfertoCaliforniaLutheranUniversityandthatIhaveachievedatleasta2.25gradepoint
average(basedon4.0=A)forallcollegeworkcompleted.
IunderstandthatofficialtranscriptsfromallcollegesattendedmustbereceivedbyCaliforniaLutheranUniversitybythirty daysfrom
today.IfIfailtoprovidetranscriptsbythisdateorifthetranscriptsdonotverifythatIhavemetallentrancerequirements,Iunderstand
thatIwillnotbepermittedtoenrollforsubsequentterms.(Non-Degree/SpecialStatusstudentsmaysubmitunofficialcopiesoftheir
transcripts.)
Haveyoueverbeenconvictedofacrime? Yes NoIfyouansweredyes,pleaseexplainthecircumstances:___________
_______________________________________________________________________________________________________________________
Icertifythattheinformationcontainedinthisapplicationiscompleteandcorrecttothebestofmyknowledge.
Student'sSignature ________________________________________________
_ ______________________________________
Signature Date
to complete the application process:
1. Returnthisapplicationformalongwitha$50.00nonrefundableapplicationfeeto:
AdultDegreeProgram
CaliforniaLutheranUniversity
60WestOlsenRoad#2200
ThousandOaks,CA91360-2700
PleasemakecheckormoneyorderpayabletoCaliforniaLutheranUniversity.
2. RequestthattranscriptsofallcollegeworkattemptedbesenttotheAdultDegreeProgramOffice.
3. Scheduleanappointmentwithaprogramcounselor(805)493-3325.
California Lutheran University does not discriminate on the basis of race, religion, sex, handicap, or national origin in any of its policies or programs.
Availability of Annual security report
AcopyoftheCaliforniaLutheranUniversityAnnualSecurityReport.Thisreportincludesstatisticsforthepreviousthreeyearsconcerningreported
crimesthatoccurredoncampus;incertainoff-campusbuildingsorpropertyownedorcontrolledbyCaliforniaLutheranUniversity;andonpublic
propertywithin,orimmediatelyadjacenttoandaccessiblefromthecampus.Thereportalsoincludesinstitutionalpoliciesconcerningcampussecurity,
suchaspoliciesconcerningsexualassault,andothermatters.YoucanobtainacopyofthisreportbycontactingtheDepartmentofCampusSafetyand
Securityorbyaccessingthefollowingwebsiteathttp://www.callutheran.
edu/safety_security/statistics/statistics.php
ADEP.3812a.06.06.1000