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ONLINE APPLICATION

GENERAL INFORMATION:

I am applying as a: *

Overseas Student

Transfer Student

Change of Status

Domestic Student

I am applying for: *

Associate of Religious Music

Master of Religious Music

Master of Business Administration and Christian Leadership

Term: *

Spring

Summer

Fall

STUDENT INFORMATION:

Last Name

First Name

Middle Name

Gender

Email

Phone Number

Date of Birth

Driver License

Country of Citizenship

City of Birth

Country of Birth

HOME COUNTRY ADDRESS

Street Address

Street Address 2

Town / City

State / Province

Country

Postal / Zip Code

Phone (Home)

U.S. ADDRESS

Street Address

Street Address 2

City

State

Zip Code

Phone US

EDUCATION:

Name of High School Graduated

Date of Graduation

State

Country

Do you have a GED Certificate?

Yes

No

If yes, give location and date

Name of College or University Attended/Graduated

Degree

Major

Date of Graduation

EMERGENCY CONTACT:

Emergency Contact Name

Phone Number

E-mail Address

Relationship

Will you be bringing dependents? *

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1

2

3

4

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Tuition and Fees

Community
Library
Donation
Contact

CONTACT

3435 Wilshire Blvd., Suite 205

Los Angeles, CA 90010
Phone 213-263-2008

info@westclaremontuniversity.org

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Certifications:

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