Hardware & software requirements - CTU Online

APPLICATION FOR ADMISSION
APPLICATION FOR:
Campus Location:
Colorado Technical University Online
4435 N. Chestnut St., Suite E
Colorado Springs, CO 80907
Are you interested in applying for Financial Aid □ Yes □ No
PERSONAL DATA
First (Given) Name Last (Family) Name Middle Initial
Applicant’s Full Legal Name _____________________________________________ SSN ______-____-______
Home Address_______________________________________________________________________________
City/State ____________________________ Country ___________________ Zip/Postal Code_______________
Work Address_______________________________________________________________________________
City/State ____________________________ Country ___________________ Zip/Postal Code_______________
Primary Phone (______) _____-______ Secondary Phone (______) ______-______ Fax (______) _____ -______
What is the best time of day to reach you _________________________________________________________
Primary e-mail____________________________ Secondary e-mail_____________________________________
U.S. Citizen □ Yes □ No
Legal Permanent Resident □ Yes (if yes, send copy of green card)
□ No
Is English your first language □ Yes □ No
If English is not your first language, have you taken a TOEFL Exam or English Proficiency Exam □ Yes □ N
Have you ever been convicted of a criminal offense (other than minor traffic offenses) Yes No If yes, please describe:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
EDUCATIONAL RECORD
Name of High School/ Secondary School____________________________________________________________
City _____________________________ State__________ Date of Graduation______________________________
Please list all colleges/ universities previously attended:
Name City State Degree Obtained Dates of Enrollment
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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