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Application for TimeSaver Admission

*Please use Mozilla Firefox or Google Chrome to complete the form below.

Personal Information
 Your full legal name:  
     Last  
     Maiden  
     First  
     Middle  
     Preferred Name  
 Home Address:  
     Number and Street  
     City  
     State  
     Zip Code  
     Country (if not USA)  

Preferred Phone Number:
(Please select a phone number type)


Secondary Phone Number:
(Please select a phone number type)


Email Address:  
Date of Birth    (mm/dd/yy)
Eligible for tuition reimbursement from employer?   
Marital Status:  
Are you a U.S. Citizen?  
If no please list country of citizenship   
The following information is optional and is requested for use on federal and state reports as well as institutional research.  This information is not used in determination of one's eligibility for admission, nor will it be used in any discriminatory manner. 
Religious Preference (optional):  
Gender (optional):  
Are you of Hispanic or Latino Origin?
Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race (optional)

  

Select one or more races from the following groups. (optional)
                                                  
 
Relative and Referral Information
Relatives who are attending, have attended, or are currently employed at Clarke University:
 1- Name  
     Relationship  
     Dates of Attendance /
     Employment
 
 2- Name  
     Relationship  
     Dates of Attendance /
     Employment
 
List anyone who referred you to Clarke University, including their relationship to the university (alum, current student, friend of the university, etc.):
      
What major are you interested in studying?  
If you are interested in a major not listed here, please apply for admission in the traditional daytime program.
 Enrollment Term:  
 Intended Credit Load:  
 Enrolling As:  
If you are applying for re-admission to Clarke, please complete the re-admission application.

 High School Information

If you have received your GED in lieu of graduation, please enter GED for Name of High School.

    Name of High School  
    City  
    State   
    Graduation/GED Date   
Beginning with the most recent, list all of the colleges and universities you have attended since high school whether or not you completed the coursework or earned any credit.
 1- Name of Institution  
     Dates of Attendance  
     Degree Earned
 2- Name of Institution  
     Dates of Attendance  
     Degree Earned
If you have more than two institutions, please list the remaining schools here:    
List the primary influences that led you to apply to Clarke University:     

Certification of Application
By typing my name below, I certify that the information I am submitting in this online application is accurate to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any schools or colleges I have previously attended or am currently attending to release my personal and academic information to Clarke University and/or its representatives. Further, I agree that my college grades may be used for statistical studies or sent to my high school or community colleges for evaluation purposes. I understand that official high school (and college) academic transcripts must be received by Clarke University before a final admission decision can be made. My signature also gives Clarke University permission to use photos of me in any promotional materials, print or electronic.
Your Name:     Date:  


 

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