Get Queens University Of Charlotte Online Maitland Fl Form

Please submit this document to the Admission Processing Center Via fax 877. 497. 5850 Via mail Queens University of Charlotte Online Admissions 851 Trafalgar Court Suite 420 W. Maitland FL 32751 Via email attachment info online. queens. edu Applicant Information Name Mr. Ms. Last First Preferred to be called nickname Middle Former last name s if any Street address City State Zip Country E-mail Home Phone Cell Phone Date of Birth mm/dd/yyyy Social Security Number Birth Country Birth City Citizenship check one U*S* Citizen U*S* Permanent Resident Visa citizen of Other citizenship country Type of visa If you choose to be identified with a racial/ethnic group please do so below check all that apply African American/Black Asian or Pacific Islander White non-Hispanic Native American/Alaska Native Hispanic/Latino Multi-racial Other Choose To Omit Academic Program Please choose the degree and focus area for which you are applying check one Master of Science in Nursing-Clinical Nurse Leader Master of Arts in Educational Leadership Semester for which you are applying check one Fall 20 Spring 20 Summer 20 Please select your enrollment status Full Time Part Time Are you expecting to receive tuition assistance/ reimbursement from one or more of the following sources check all that apply Employer Veterans Affairs Federal Financial Aid Previous Education Please provide college information below. College s Attended Institution Name Start Date End Date GPA Major Degree Earned/To be earned Occupation Employer/Organization Name Work Phone Recommenders Phone Number Have you ever applied to Queens University of Charlotte before No Yes. If yes when Have you ever attended Queens University of Charlotte Application Verification Signature Checking this box and typing my name below will serve as my electronic signature. I hereby certify that I have personally completed this form and that the information is complete and accurate. I understand that all credentials submitted in support of this application become the property of the University and are not returnable. Signature Date NOTE TO APPLICANTS No person will be denied admission to the or otherwise be discriminated against at Queens University of Charlotte on the basis of race color religion sex national origin age marital status personal appearance family responsibilities physical or mental disability matriculation political affiliation or status as a Vietnam Era or disabled veteran insofar as any of these classes are defined and protected by Federal and North Carolina laws and regulations. queens. edu Applicant Information Name Mr. Ms. Last First Preferred to be called nickname Middle Former last name s if any Street address City State Zip Country E-mail Home Phone Cell Phone Date of Birth mm/dd/yyyy Social Security Number Birth Country Birth City Citizenship check one U*S* Citizen U*S* Permanent Resident Visa citizen of Other citizenship country Type of visa If you choose to be identified with a racial/ethnic group please do so below check all that apply African American/Black Asian or Pacific Islander White non-Hispanic Native American/Alaska Native Hispanic/Latino Multi-racial Other Choose To Omit Academic Program Please choose the degree and focus area for which you are applying check one Master of Science in Nursing-Clinical Nurse Leader Master of Arts in Educational Leadership Semester for which you are applying check one Fall 20 Spring 20 Summer 20 Please select your enrollment status Full Time Part Time Are you expecting to receive tuition assistance/ reimbursement from one or more of the following sources check all that apply Employer Veterans Affairs Federal Financial Aid Previous Education Please provide college information below. College s Attended Institution Name Start Date End Date GPA Major Degree Earned/To be earned Occupation Employer/Organization Name Work Phone Recommenders Phone Number Have you ever applied to Queens University of Charlotte before No Yes.