(over)

Fall 20_____

Please type or print the following and return to the Office of Graduate Admissions

Spring 20_____ Summer 20_____ n Undergraduate n � Graduate

Legal NameAs it appears on legal documents First Name Full Middle Name Last Name

Nickname Maiden Name Suffix n Jr. n II n III n Other

Gender n Male n Female Social Security Number – –

Birth Date / / Email Addressmm dd yyyy

Home Phone Number ( ) - Cell Phone Number ( ) -

Permanent Home Address

If different from above, please give your current address to which all admissions information will be sent.

Mailing Address

Citizenship n U.S. Citizen n Dual U.S. Citizen n U.S. Permanent Resident n Other Citizenship

Country(ies) of Citizenship

Country of Residence

Alien Registration Number

If you are not a U.S. citizen and live in the United States, how long have you been in the country?

OPTIONAL INFORMATION (Information provided is not used in a discriminatory manner.)

Place of birth

First language, if other than English

Language spoken at home

If you wish to be identified with a particular group, please check all that apply:1) Are you Hispanic or Latino? n Yes n No2) Check one or more of the following groups in which you consider yourself to be a member:n Native American or Alaskan Native n Black or African American n Whiten Native Hawaiian or Other Pacific Islander n Asian

Religious Preference n Buddhist n Islamic n Hindu n Jewish

n Catholic If Roman or Orthodox Catholic, specify your (arch) diocese

n Christian Specify denomination

n Other

RE-ADMISSION CHECKLIST

A student who has been dismissed or has withdrawn, or who is presumed to have withdrawn because of failure to maintain continuous enroll-ment, must reapply for admission to The Catholic University of America. A student who is re-admitted, upon registration, will incur a $100 re-admission fee on their student account.

THE CATHOLIC UNIVERSITY OF AMERICARE-ADMISSION APPLICATION

CUA

Official copies of academic transcripts. PLEASE NOTE: If you attended CUA prior to 2001, you must request your CUA transcript from Enrollment Services at http://enrollmentservices.cua.edu

Completed and signed nondegree application

Statement of Re-Admission

Have you ever been convicted of a crime (other than a minor traffic violation)? n Yes* n No

Have you ever been sanctioned by a school, resulting in probation and/or suspension? n Yes* n No

*If yes, please explain on a separate sheet of paper and attach to your application.

STATEMENT OF RE-ADMISSION: On a separate page, please explain your reason(s) for requesting re-admission to The Catholic University of America. Please provide any information that will assist your explanation.

I understand and agree that this application and any other information received by the Office of Admissions are property of The Catholic University ofAmerica and shall be considered confidential. An enrolled student’s access to his/her education records is governed by CUA’s Student Records Policy.Certain items are excluded from access, including parents’ financial records and documents and letters of recommendation to which the student has previouslywaived access.

I understand and agree that The Catholic University of America is a private institution and, as such, retains the right to terminate a student's matriculationat any time his or her academic performance is seriously deficient or his or her conduct becomes injurious to the maintenance of good order or disruptive tothe academic atmosphere.

I affirm the information and statements contained in this application are, to the best of my knowledge, true, correct and complete. I agree to promptly notify The Catholic University of America of any changes to this application.

Further Information for Applicants: Online Student Handbook: studenthandbook.cua.edu

Required Title IV and IX Disclosures: counsel.cua.edu/StudLife/publications/consumerinfo.cfm

Information for Students with Disabilities: dss.cua.edu

Student’s Signature Date

SELECT THE ACADEMIC SCHOOL TO WHICH YOU ARE APPLYING

What program/major are you applying for?

Were you previously enrolled in this degree program? n Yes n NoIf not, in which degree program were you enrolled? Date of last attendance at CUA n Fall n Spring Year Were you in good standing at that time? n Yes n NoIf no, explain

EDUCATIONAL DATAHave you attended another institution since leaving CUA? n Yes n NoIf yes, please submit official transcripts. Indicate college(s) attended below:Name/Location Dates of Attendance GPA Major Degree Awarded

From: To: (if applicable) and Date

�n School of Architecture and Planning�n School of Arts and Sciences�n School of Business and Economics�n School of Engineering�n Benjamin T. Rome School of Music

n School of Nursingn School of Philosophyn School of Canon Law (graduate only)n National Catholic School of Social Servicen School of Theology and Religious Studies (graduate only)

Mail to: The Catholic University of America, Office of Graduate Admissions, 620 Michigan Ave., N.E., Washington, DC 20064

The Catholic University of America admits students of any race, color, national or ethnic origin, sex, age, or disability.