Eastern Mennonite University

Entrance Date

Enrollment Category*
Term of Enrollment*

Personal Information

(as requested by the U.S. Department of Education)
First name*
Preferred Name*
Middle
Family name (surname)*
Social Security Number
Birth date* Year:
How did you hear about the program?*

Current Address

Street/P.O. Box*
City*
State or province
If you are a Virginia resident, what is the county or independent city in which you reside?
Country*
Zip code - [look up U.S. or Canadian codes]
Home phone number (please include area code)
Office phone number (please include area code)
Cell phone number (please include area code)
FAX number (please include area code)
E-mail address #1*
E-mail address #2

 

Citizenship Information

Are you a citizen of the United States?*

If you are not a U.S. citizen, please complete the following questions:

Country of citizenship
Do you currently hold a U.S. visa?
If yes, what type of visa do you hold? (for example, A1, B1, F1, F2 )
Permanent resident or alien registration number, if applicable:
Country of birth:
City of birth:
( If you are a permanent resident you must send a photocopy of both sides of your alien registration card. No financial documents are needed. )

Religious Affiliation

Religion (optional)
If Mennonite:
Conference (optional)
If Mennonite:
Congregation (optional)

Academic Credentials

School attended* Address Dates attended Degree earned


From Year:
To: Year:
Month:
Year:
 


 From Year:
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Month:
Year:
 


 From Year:
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Month:
Year:
 


 From Year:
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Month:
Year:
 


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To: Year:
Month:
Year:

All students educated abroad or whose native language is not English are required to take the TOEFL. Those students who hold or will earn a degree from an accredited institution in the United States before enrolling at Eastern Mennonite University may have this requirement waived.
Have you taken the TOEFL?
Date you took or plan to take the TOEFL:

References

Three letters of recommendation are required for degree applicants (preferably one academic, one professional, one personal). Please tell us who your references are. Follow the instructions on the Confidential Letter of Recommendation (Note: 3 required for M.A., 2 required for Certificate)

Name of Individual Title/Position
* *
* *

Optional Information

Ethnic background:
Gender:

Statement of Intent

I hereby certify that the information given by me on this application form and supporting credentials is complete and truthful. I understand that if any information furnished by me is found to be untrue, I may be denied admission, or if admission has been granted, I may be subject to disciplinary action, including dismissal from Eastern Mennonite University.