EMBA National Guard Application Form

Please note:  In order to complete this application, you must provide names, addresses, positions and organizations of two individuals who will provide recommendations for you.  Make sure you have this information before completing the application.

Required fields are in bold. These fields must be completed before you can successfully submit the form.  

Personal Information
Expected Enrollment Date	(Select) Fall 2012 Spring 2013
First Name
Middle Name
Last Name
If you have used a different name, please give that name
Gender	Female Male
Date of Birth	[None]
Permanent Mailing Address
City
State
Zip Code
County
Country
Daytime Phone (including area code)
Cell Phone (including area code)
Email
Current Address Information (if different from address listed above)
Current Mailing Address
City
State
Zip Code
County
Last date to receive mail at this address	[None]
State of legal residence
How long have you lived there?	(please enter number of years and months e.g. 2 yrs  4 mnths)
Are you currently a West Virginia resident?	(Select) Yes No
Place of birth (state)
If you have previously applied for graduate admission to UC, indicate year - term/semester
If you have been previously or are currently registered at UC, indicate year - term/semester
Educational Institutions  List all educational institutions you have attended beyond high school. Attach a separate sheet if necessary. Include a copy of the transcripts of all college work from each institution in your application packet. Submit electronically to cherylfout@ucwv.edu.  Note:  An official, original transcript for your highest earned degree must be provided before the first day of class.
Undergraduate Institution
City/State
Date
Credit Hours
Degree Earned
Major
Dates Attended	From    to
Graduate Institution
City/State
Date
Credit Hours
Degree Earned
Major
Date Attended	From   to
Employment History On a separate resume, please include your full-time employment history in reverse chronological order, beginning with most recent position. Military, Peace Corps, entrepreneurial or business ventures should be integrated into this list. Resume may be submitted electronically to cherylfout@ucwv.edu.
How many years of post-undergraduate full-time work experience:
Recommendations Provide names, addresses, positions, and organizations of two individuals who will provide recommendations for you. Send them the confidential recommendation form after you have completed the top portion of the form.
Recommendation 1
Name
Address
City, State Zip Code
Organization
Position
Phone Number
Recommendation 2
Name
Address
City, State Zip Code
Organization
Position
Phone Number

The University of Charleston does not discriminate on the basis of race, color, sex, religion, handicap, age, national or ethnic origin in the administration of our educational policies, admission policies, scholarship and loan programs, athletic activities or other school-administered programs.

By submitting this form online, I hereby apply for admission to the Executive MBA National Guard Program at the School of Business of the University of Charleston. I certify that all statements are correct and complete. I understand that all documents submitted in support of this application become the property of the University of Charleston and will not be returned. If admitted, I agree to observe all the rules and regulations of the University of Charleston. Failure to comply can result in University disciplinary action.