Northeastern University College of Professional Studies: How to apply

Undergraduate Application

First Name:
Last Name:
Social Security Number:

HOME ADDRESS (Unless otherwise specified, this address will be used for billing and all correspondence.)
Street:

City:
State:
Zip:
Home Phone:
E-mail Address:

EMPLOYMENT/EMPLOYER INFORMATION
Are you employed? Part-time Full-time Not Employed
Your Organization/Firm Name:
Your Title:
Street:

City:
State:
Zip:
Business Phone:

STUDENT INFORMATION
Are you a new or continuing student at SPCS (formerly University College)? New Continuing
Are you an Alumnus of Northeastern University? Yes No Year graduated:
If not an Alumnus, have you ever taken a course at Northeastern? Yes No If yes, please indicate course and year:
Have you ever been registered under another name in any other institution? Yes No If yes, please indicate:

PERSONAL INFORMATION

Date of Birth (mm/dd/yy):

Male
Female

The United States Office of Civil Rights respects that schools report enrollment by selected minority groups. This is to determine compliance with the Civil Rights Act of 1964 and continued eligibility of Northeastern University for federal funds such as student financial aid.

Race or Ethnic Group:
American Indian, Alaskan Native
Foreign National
Black, Non-Hispanic
White, Non-Hispanic
Asian or Pacific Islander
Hispanic/Latino(a)
Do Not Wish To Respond

U.S. citizen?
Yes
No

If no, permanent resident?
Yes
No

Country of Citizenship:

Country of Birth:

INTERNATIONAL STUDENTS

International Students must submit TOEFL scores.

TOEFL:

Self Reported TOEFL score:

Date of Test:

Score:

U.S. VISA STATUS (check one)
Student
Exchange Student
Permanent Resident
Diplomatic
Other, please specify

SELECT TERM TO BEGIN:
SPRING 2006
SUMMER 2006
FALL 2006
WINTER 2006
SPRING 2007

PLEASE SELECT PROGRAM:
Bachelors Degree
Associates Degree
Undergraduate Certificate
Returning Scholars Adult Transition Program
Professional Degree Completion Program
Undecided

OPEN ADMISSION AND CERTIFICATE PROGRAMS:
Please select the program/major to which you are applying.

Bachelor's Degrees

Associate Degrees

Certificates

Other
Returning Scholars Adult Transition Program
Professional Degree Completion Program
Undecided

EDUCATION BACKGROUND

High School Transcripts
If you can not send a copy of your official high school diploma, transcripts or GED, please complete the following (We reserve the right to ask for official high school transcripts if we deem it necessary):

Name of School:

Date of graduation:

Location (City, State):

Phone #:

MCAS Score (if applicable):

Maiden Name or other legal name used in high school:

College Experience

Name of School	Date Attended	Year of graduation	Do you intend to transfer credit from this institution?
			Yes No
			Yes No

Transfer Credit/Life Experience Credit

I would like to discuss the following type(s) of transfer credit:
AP Advanced Placement
APL Assessment of Prior Learning
CLEP/Dantes/Excelsior Credit by Examinations
Credit from another institution(s)

	Name:
	Name:
	Name:

Licenses and Certifications

	List:

Modern Language Proficiency Exam
Workplace Training Programs/Courses
Other, please specify: