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Step 1
APPLICANT INFORMATION
+ Denotes Required Field
required  First Name: 
 required  Mailing Address: 
required  Last Name: 
 required  City: 
required  Maiden Name: 
required  State: 
required  Zip Code: 
 required Social Security Number: 
 required  Sex:   
required  Date of Birth: 
  Permanent Address (If other than above):
required  Are you a U.S. or Canadian citizen/resident?
    		  City:
 If no, which visa do you hold?
 State:
 Zip Code:
required  Country of Citizenship:
 required  Email Address: 
 Ethnic Origin:
Business Phone:   ext. 
required Home Phone:
Mobile Phone:
(Submission of this information is optional. It is used to determine the effectiveness of
efforts to provide equal education opportunity. These are federally designated categories.)
EMPLOYMENT/REIMBURSEMENT INFORMATION
 Are you currently employed?  
 Employer:
 Are you applying for Financial Aid?
Are you a spouse or dependent of a City University employee?
Name of employee:
CHOOSE YOUR ADMISSIONS COUNSELOR
 If you've spoken with a counselor please choose their name below.
 Counselor: 
Step 2
PROGRAM INFORMATION
+ Denotes Required Field
required  Please mark the program to which you are applying [choose one]:
SCHOOL OF MANAGEMENT
UNDERGRADUATE










GRADUATE

SCHOOL OF ARTS AND SCIENCES
UNDERGRADUATE



with an Emphasis in Criminal Behavior
CERTIFICATES


Step 3
EDUCATIONAL HISTORY & TRANSCRIPT INFORMATION
+ Denotes Required Field
required  Which month are you applying for:    Year: 
Have you applied to City University previously?
If yes, which quarter?
HIGH SCHOOL INFORMATION
required Name:
required City: required State: required Graduation Year:
TRANSCRIPT INFORMATION
Will you be requesting transcripts from another institution?
Are you submitting transcripts/test scores from an organization other than a college or university (i.e. CLEP, DANTES)?
MILITARY INFORMATION (OPTIONAL)
Military Status:  
If Active Duty or Active Reserve, provide your military installation (base):
Are you submitting military transcripts for evaluation?
If yes, provide the following: Rank, Rate & Rating or Military Occupational Specialty (MOS):


required  Signature: 
required  Date: