Personal Data












/ Select the month /

(###-###-####)

Male or Female

(###-###-####)

Single or Married

Main Phone Secondary Phone Email

Yes No

Yes No

Anticipated Enrollment Information

Masters of Education

Choose One

Curriculum and Instruction
Sports and Exercise Leadership
Teacher Certification

Master of Arts in Religion
Master of Arts in Counseling
*Master of Business Administration


Year: Term:

Yes No

If you have a physical disability that will require special accommodation, you must contact the Office of Advising in writing at least 60 days before classes begin to see what arrangements can be made. You will need to explain your circumstances and accommodation requests.

Yes No


Additional Information (This information will be used in a non-discriminatory manner, consistent with applicable civil rights laws)

  • Alumni
  • Church Staff Member
  • High School Counselor
  • Admissions Counselor
  • Attended Summer Camp at ETBU
  • Rec Team
  • Scholarship/Financial Aid
  • ETBU Faculty/Staff Member
  • Parents/Siblings
  • Magazine Ad
  • Location
  • College Fair
  • Current Students
  • Website
  • Academic Program
  • Campus Visit

Universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own university communities, to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions:


Yes No

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Native Hawaiian or Pacific Islander
  • White
Academic Background

Please list each College and/or University in Order of Attendance.
NameCity / StateYears attended and Degrees

Please list each College and/or University in Order of Attendance.
NameCity / StateYears attended and Degrees

Signature

ETBU has my permission to verify the information contained in this application. I consent to the release of information concerning my academic and/or financial status to scholarship donors. I understand that if any information on this form is found to be inaccurate or incomplete, it will be sufficient cause for rejection or dismissal.

I agree that if my student account, for any semester enrolled, becomes delinquent and all methods of collection have been exhausted by the University, my account will be turned over to a third party collector and I will be responsible for all collection and legal fees.

Check to electronically sign.