APPLICATION FOR ADMISSION
MASTERS OF EDUCATION
If you need help or have any questions, please call us at 1-800-662-3303 ext. 5200 or (712) 279-5200
Please select a speciality:
Applied Behavior Analysis
Leadership and Learning
Check the semester you would like to begin.
Fall
Spring
Year
Type of Admission Requested
Non-Degree Status
Degree Status
Is this your initial request for admission to graduate study at Briar Cliff University?
Yes
No
If you have applied for admission to graduate studies previously, indicate term or year:
Personal Information
Fist Name
Middle Name
Last Name
Home Address
City
State
Zip
Home Phone
Cell Phone
Social Security Number
Date of Birth (mm/dd/yyyy)
City of Birth
State of Birth
Country of Birth
Country of Citizenship
If you are a permanent resident alien (PRA), list your PRA Number.
Mariage Status
Maiden or Former Name
Married
Single
Gender
Male
Female
Email Address
Ethnicity & Race
Select one or more of the following categories:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Hispanic / Latino
White
Religious Affiliation (optional)
Military Experience
Veteran
Non-Veteran
Now in Service
Military Training
Other
Do you expect to recieve any VA benefits while attending BCU?
Yes
No
Do you expect to be employed while attending graduate school?
Yes
No
Employer
Position
Office Phone
City
State
Zip
Can you conveniently receive calls at work?
Yes
No
Education
School
City / State
Years Attended
to
to
to
to
to
Please indicate which of the following computer-based skills you feel competent in:
Word Processing
Literature Searching
Web-based Searches
Spreadsheets or Databases
It is hereby certified that the information given in this application is tru and correct. It is understood that misrepresentation, omission of information, or failure to answer any single question may cause delay or cancellation of admission. For the purpose of determining admission, I hereby authorize any educational institution, which I have previously attended, and officials at such institution to release academic and disciplinary records and to discuss these records with appropriate officials at Briar Cliff University.
I accept the right of the Graduate School to exercise academic sanctions against me in the event that I fail to:
This information is sought for the purpose of considering your request for admission to the University. Only with your permission will information be released to a third party.
Copyright 2010 by Briar Cliff University