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Application for Admission
Division of Continuing Education
Credit Certificate Program
Mr.
Ms.___________________________________________________________________
Mrs. Last First Middle
Address (Street) ________________________________________________________
______________________________________________________________________
City State Zip
Telephone: (_____)_____________ Social Security #___________________________
E-Mail Address: _______________________________________________________
PLEASE CHECK ONE
_____ Certificate in Womenfs Studies _____ Certificate in Computer Security
Date of Birth____________________________Male _____Female ________
Place of Birth_______________________________________________________
Country of Citizenship________________________________________________
Type of Visa (if not a U.S. citizen)_______________________________________
Race: African American/Black Asian or Pacific Islander Hispanic White, non-Hispanic
(optional)
EMPLOYMENT HISTORY
Present Employer____________________________________________________
Current Position_____________________________________________________
Telephone (____)_______________
Employer Address (Street)____________________________________________
__________________________________________________________________
City State Zip
List your past employment record. If you have not been employed full time, list summer and
part-time work if relevant to this application.
Employer Position Inclusive Dates
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
EDUCATIONAL BACKGROUND
High School___________________________________________ Year of Graduation_______
List in colleges and universities attended
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Institution
Name |
City & State or Country |
Dates
Attended |
Major |
Degree Earned or Number of credit hours earned |
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Are you currently enrolled in The University of Tulsa? ___Yes ___No
Have you previously attended The University of Tulsa? ___Yes ___No
If yes, which division(s) and when?________________________________________________
If you have met with a faculty member or a University of Tulsa advisor please indicate his/her
name:______________________________________
