Application for Resident Graduate Admission Please complete this application and all supplemental forms, and return them with a $50 application fee. Supplemental forms vary by degree program. Visit www.Liberty.edu/ResidentGraduate for details. Biographical Information Name First/Given Mailing Address Middle/Maiden Last/Surname Street Address State/Province City ZIP/Postal Code Country Home Phone Cell Phone* Work Phone *By submitting my information through this form, I agree that Liberty University and its affiliates may call and/or text me about its educational offerings at the phone number(s) provided, including any wireless number, using an automated technology. I understand that I am not required to submit this form or give this consent to be able to apply to or attend Liberty University. Please select your primary phone: Home Cell Work Have you ever been convicted of a felony or misdemeanor? _____ Yes _____ No (If you answered “Yes,” please provide a written explanation on a separate sheet of paper or by email to [email protected]) Email Address Gender: Male U.S. Citizen: Female Yes No Date of Birth (mm/dd/yy) Citizenship (if other than the U.S.) Yes If not a U.S. Citizen, are you a legal permanent resident of the U.S.? No If yes, please provide your Alien Registration Number Marital Status: Single Married Widowed Separated Divorced American Indian or Alaskan Native (including all Original Peoples of the Americas) Please select your highest level of academic achievement: Bachelor’s degree Doctoral degree Master’s degree Post-master’s degree or certificate First professional degree (M.Div., J.D.) Where did you first hear about The Graduate School at Liberty University? Print advertisement Word of mouth Website TV Conference Other____________ Please indicate how you identify yourself. (Check all that apply) Asian (including Indian subcontinent and Philippines) Black or African-American (including Africa or Caribbean) Native Hawaiian or Other Pacific Islander (Original Peoples only) White or Caucasian (including Middle Eastern) Hispanic or Latino (including Spain) NONDISCRIMINATION STATEMENT Liberty University does not engage in unlawful discrimination or harassment because of race, color, religion, creed, national origin, ancestry, ethnicity, sex, marital status, disability, age, or veteran status in its educational programs and activities. Liberty University maintains its Christian character but does not discriminate on the basis of religion, except to the extent that applicable law respects its right to act in furtherance of its religious objectives. The university will provide reasonable academic accommodations [(434) 582-2159 or [email protected]] and reasonable physical access accommodations [(434) 592-4107 or [email protected]] to those with qualifying disabilities. The following persons have been designated to coordinate Liberty University’s compliance with certain anti-discrimination laws: Edwina Berryman Disability (Online Students) [email protected] Denny McHaney Disability (Resident Students) [email protected] (434) 582-2159 Brittney Wardlaw Title IX Coordinator (Student Conduct) [email protected] (434) 582-2320 Laura Wallace Title IX/Sex & Disability (Employment) [email protected] (434) 592-7330 Previous Education 1. 2. 3. College(s) attended (Use additional sheets if necessary.) Name of college/university City State Last name under which you attended Years attended Name of college/university City Last name under which you attended Years attended Name of college/university City Last name under which you attended Years attended Degree earned State Degree earned State Degree earned Military Information Status: Branch: Active Air Force Reserves Veteran Department of Defense Army Coast Guard Marines National Guard Navy Academic Year and Degree Selection Fall Term (Aug.-Dec.) Academic Year Spring Term (Jan.-April) Indicate your intended degree program:_______________________________________ You may choose one degree from the list of programs at www.Liberty.edu/ResidentGraduate. Please contact a Resident Graduate admissions counselor if you have any questions. Summer Term (May-July) Verify summer course availability with the academic department. Summer enrollment may not be available to international students. Nonrefundable Application Fee ($50) Check/Money Order (enclosed) Credit Card # Security Code Exp. Date I have graduated from Liberty and would like to pursue another degree. Please waive my application fee. I am a current Liberty student. Please waive my application fee. Student ID # Degree Completed Statement and Signature Year of Graduation (Please review the application for accuracy before signing.) An applicant applying for admission shall pay a $50 application fee. This application fee is nonrefundable and nontransferable. This fee cannot be applied toward other university charges. The application and its fee may be deferred for one academic year. 1. The university may make such investigation as it deems proper in connection with this application, and will treat as confidential all information submitted herein or received by the university from any source including, without limitation, the applicant or his/her family. An applicant may review any information gathered. 2. The provision concerning fixing the amount, adjustment on withdrawal or late arrival, and other terms of comprehensive fee payment as set forth in the university’s annual catalog are incorporated herein and are hereby accepted. 3. The Graduate School Code of Honor addresses the appropriate academic and personal conduct expected of graduate students and is an integral part of the Liberty University community. The Code of Honor, an expression of the values inherent in the university’s doctrinal statement, defines the rules and principles by which our community functions. At the core of this code are two key concepts: a belief in the dignity of all persons and an insistence on the existence of objective truth. Graduate students are expected to respect and uphold these standards while registered at Liberty University. All students will be required to read and indicate compliance to the Code of Honor prior to matriculation. I certify that the information provided on this application is complete and accurate to the best of my knowledge, and that Liberty University is authorized to make whatever inquiries are necessary to certify the accuracy of my records. I understand that withholding or giving false information will make me ineligible for admission or result in dismissal from Liberty University. I understand and agree that Liberty University may disclose information from my education records to appropriate government agencies for the purpose of assisting such agencies in the administration of financial aid programs or to address matters of public health and safety. I understand that my enrollment to the university is conditional upon agreement to the Code of Honor. The mission of Liberty University is to develop Christ-centered men and women with the values, knowledge, and skills essential to impact the world. We expect that our students understand and respect our mission and purpose while enrolled at Liberty University. Signature Date Office of Resident Graduate Admissions 1971 University Blvd. Lynchburg, Va. 24515 | P: (877) 298-9617 | F: (434) 522-0430 [email protected] | www.Liberty.edu/ResidentGraduate
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