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Name and Contact Information
First Name
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Citizenship
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U.S. Citizen
U.S. Permanent Resident
Dual Citizen of U.S. and Another Country (in U.S.)
Dual Citizen of U.S. and Another Country (outside U.S.)
Other
U.S. Refugee or Asylee
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Country of Citizenship
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Afghanistan
Aland Islands
Albania
Algeria
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, the Democratic Republic of the
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Czechoslovakia
Dahomey
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
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Eritrea
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French Polynesia
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Ghana
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Grenada
Guadeloupe
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Mali
Malta
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Moldova, Republic of
Monaco
Mongolia
Montenegro
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Morocco
Mozambique
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Namibia
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New Caledonia
New Zealand
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Niger
Nigeria
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Papua New Guinea
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Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
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Slovakia
Slovenia
Solomon Islands
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South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
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Syrian Arab Republic
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Tanzania, United Republic of
Thailand
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Turkey
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Turks and Caicos Islands
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Uganda
Ukraine
United Arab Emirates
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United States
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Vietnam
Virgin Islands, British
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Academic Information
I wish to take classes:
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On Campus - Day
On Campus - Weekend/Evening
Online
Degree Level
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Bachelor's
Master's
Doctorate
Certificate
Student Type
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First-time Freshman
Transfer
Undergraduate
Graduate
Graduate
Graduate
Anticipated Program
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Accounting
Accounting Information Systems
Actuarial Science
Art (Studio)
Biochemistry
Biology
Biomedical Science
Biotechnology
Business Administration
Chemistry
Communication
Communication Sciences and Disorders
Computer Science
Criminal Justice/Criminology
Cyber Security
Data Science
Early Childhood Education
Elementary Education
Engineering (Dual Degree)
English
Exercise Science
Financial Services
Forensic Psychology/Criminal Justice
Forensic Science
Game Design
Graphic Design
History
Interactive Design
Interior Design
International Business
International Studies
Liberal Studies
Management Information Systems
Marketing
Mathematics
Medical Laboratory Science
Middle Level Education
Music Therapy
Nursing
Occupational Therapy (Early Admit)
Organizational Leadership
Photography and Digital Art
Physical Therapy (Direct Entry)
Pre-Athletic Training
Pre-Chiropractic Medicine
Pre-Dentistry
Pre-Law
Pre-Medicine
Pre-Occupational Therapy
Pre-Optometry
Pre-Osteopathic Medicine
Pre-Pharmacy
Pre-Physical Therapy
Pre-Physician Assistant
Pre-Podiatric Medicine
Pre-Veterinary
Psychology
Psychology/Sociology
Science
Secondary Education
Sociology
Speech Pathology (Early Admit)
Sport Business Management
Sustainability and Environmental Stewardship
Undecided
Anticipated Program
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Accounting
Accounting Information Systems
Actuarial Science
Art (Studio)
Biochemistry
Biology
Biomedical Science
Biotechnology
Business Administration
Chemistry
Communication
Communication Sciences and Disorders
Computer Science
Criminal Justice/Criminology
Cyber Security
Data Science
Early Childhood Education
Elementary Education
Engineering (Dual Degree)
English
Exercise Science
Financial Services
Forensic Psychology/Criminal Justice
Forensic Science
Game Design
Graphic Design
History
Interactive Design
Interior Design
International Business
International Studies
Liberal Studies
Management Information Systems
Marketing
Mathematics
Medical Laboratory Science
Middle Level Education
Music Therapy
Nursing (Fast-Track)
Organizational Leadership
Photography and Digital Art
Pre-Athletic Training
Pre-Chiropractic Medicine
Pre-Dentistry
Pre-Law
Pre-Medicine
Pre-Occupational Therapy
Pre-Optometry
Pre-Osteopathic Medicine
Pre-Pharmacy
Pre-Physical Therapy
Pre-Physician Assistant
Pre-Podiatric Medicine
Pre-Veterinary
Psychology
Psychology/Sociology
Science
Secondary Education
Sociology
Speech Pathology (Early Admit)
Sport Business Management
Sustainability and Environmental Stewardship
Undecided
Desired Program
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General Studies with a concentration in Healthcare - Pre-Nursing
Desired Online Program
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Accounting
Business Administration
Communication
Communication Sciences and Disorders
Criminal Justice/Criminology
Cyber Security
Data Science
Digital Media
English
Financial Services
Forensic Psychology/Criminal Justice
General Studies with a concentration in Healthcare
Healthcare Management
History
International Studies
Liberal Studies
Management Information Systems
Marketing
Mathematics
Nursing - RN to BSN Completion
Organizational Leadership
Psychology
Senior Living Management
Sociology
Sport Business Management
Desired Program
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Series 7
Desired Online Program
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Community Paramedic Certificate Program
Desired Program
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Actuarial Science
Business Administration
Data Science
Master of Arts in Education
Master of Arts in Educational Leadership with Principal Certification
Master of Arts with Certification in Early Childhood Education
Master of Arts with Certification in Elementary Education
Master of Arts with Certification in Middle School - English/Language Arts
Master of Arts with Certification in Middle School - Mathematics
Master of Arts with Certification in Middle School - Science
Master of Arts with Certification in Middle School - Social Science
Master of Arts with Certification in Reading/Literacy Specialization
Master of Arts with Certification in Secondary Education - Biology
Master of Arts with Certification in Secondary Education - Chemistry
Master of Arts with Certification in Secondary Education - English
Master of Arts with Certification in Secondary Education - Mathematics
Master of Arts with Certification in Secondary Education - Social Science
Music Therapy
Occupational Therapy
Rehabilitation Counseling
Speech-Language Pathology
Strategic Communication and Leadership
Desired Online Program
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Accounting
Accounting (Bridge to MS)
Adult-Gerontology Acute Care Nurse Practitioner
Adult-Gerontology Primary Care Nurse Practitioner
Business Administration
Business Data Analytics
Cyber Security
Data Science
Family Nurse Practitioner
Health Administration
Management and Leadership
Pediatric Primary Care Nurse Practitioner
Psychiatric Mental Health Nurse Practitioner
Software Development
Strategic Communication and Leadership
Desired Program
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Educational Leadership
Higher Education Leadership
Principal Bridge to Doctorate in Educational Leadership
Teacher Leadership
Desired Online Program
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BSN to DNP Adult-Gerontology Acute Care Nurse Practitioner
BSN to DNP Adult-Gerontology Primary Care Nurse Practitioner
BSN to DNP Family Nurse Practitioner
BSN to DNP Pediatric Primary Care Nurse Practitioner
BSN to DNP Psychiatric Mental Health Nurse Practitioner
DNP with NP Concentration: Adult-Gerontology Acute Care NP
DNP with NP Concentration: Adult-Gerontology Primary Care NP
DNP with NP Concentration: Family NP
DNP with NP Concentration: Pediatric Primary Care NP
DNP with NP Concentration: Psychiatric Mental Health NP
Doctor of Nursing Practice
Higher Education Leadership
Desired Program
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Post Bac Early Childhood Education Certification
Post Bac Elementary Education Certification
Post Bac Middle School Certification - English/Language Arts
Post Bac Middle School Certification - Mathematics
Post Bac Middle School Certification - Science
Post Bac Middle School Certification - Social Science
Post Bac Reading Specialist Certification
Post Bac Secondary Certification - Biology
Post Bac Secondary Certification - Chemistry
Post Bac Secondary Certification - English
Post Bac Secondary Certification - Mathematics
Post Bac Secondary Certification - Social Science
Desired Online Program
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Post-Master's Certificate: Adult-Gerontology Acute Care NP
Post-Master's Certificate: Adult-Gerontology Primary Care NP
Post-Master's Certificate: Family NP
Post-Master's Certificate: Pediatric Primary Care NP
Post-Master's Certificate: Psychiatric Mental Health NP
Desired Location
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Main Campus
Scott Air Force Base
Anticipated Start Term
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Spring 2020 (January)
Fall 2020 (August)
Spring 2021 (January)
Fall 2021 (August)
Spring 2022 (January)
Fall 2022 (August)
Spring 2023 (January)
Fall 2023 (August)
Spring 2024 (January)
Fall 2024 (August)
Spring 2025 (January)
Fall 2025 (August)
Spring 2026 (January)
Fall 2026 (August)
Current/Most Recent High School
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School Name
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School City, State/Province
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Mailing State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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