ADMISSION APPLICATION GRADUATE PROGRAMS

GENERAL INFORMATION

Male  Female  Social Security Number:  JMVU ID Number:  Full Name: - - Other Names Used (if applicable):  Permanent Address: Place of Birth: Nationality: Date of Birth: M/d/yyyy Telephone: Cell Phone: Email: Work Phone: Have you ever applied to JMVU?    YES  NO Are you a JMVU employee?    YES  NO If yes, what program(s) have you been enrolled in?   Are you a U.S. citizen?    YES  NO Are you a Florida resident?    YES  NO Is English your first language?    YES  NO If no, what is your first language?   Ethnic Group: Hispanic White (not of Hispanic origin) Black (not of Hispanic origin) Asian American Indian or Native Alaskan Other (please specify):

REQUIREMENTS

Submit this complete form to the Admissions Office accompanied by a $50.00 non-refundable fee, by certified check, personal check or money order made payable to Jose Marfa Vargas University. Undergraduate Diploma. Completed out of the United States: provide translation from a company authorized by the National Association of Credential Evaluation Services (NACES). Official transcripts must be mailed directly from accredited institutions attended by the applicant to Jose Maria Vargas University, Admissions Department, 8300 South Palm Dr. Pembroke Pines, FL 33025 Completed out of the United States: provide translation from a company authorized by the National Association of Credential Evaluation Services (NACES). Provide Government Issued ID.

EDUCATIONAL HISTORY

List all colleges/universities and professional schools attended in chronological order starting with the most recent. Failure to list all institutions could result in having your application denied or admission rescinded. Name and Location Date of Attendance Degree or Diploma and Date Conferred GPA Credit Hrs. Earned/Expected to be Earned From To

OCCUPATIONAL HISTORY

Employer From To Occupation/Postition Title Supervisor Phone Number

STATEMENTS OF FACT

1. Have you ever been convicted or found guilty, regardless of adjudication, of a crime in any jurisdiction, pleaded nolo contendere (no contest), to any charges in any jurisdiction or have you ever been a defendant in a military court-martial?    YES  NO 2. Do you have any administrative or criminal actions pending before any forum?    YES  NO 3. Have you ever been charged with a criminal violation before any forum?    YES  NO 4. Have you ever been charged with or subject to disciplinary action for scholastic or any type of misconduct at any educational institution?    YES  NO 5. Have you ever had any professional license revoked, suspended, or had any disciplinary action taken against you by a professional regulating body?    YES  NO If you answered yes to any of the above, you must submit a full statement of relevant facts on a separate sheet and attach it to this form. You may be required to furnish the University with copies of all official documents explaining the final disposition of related proceedings.

EMERGENCY CONTACT

Name: Relationship: Address:        E-mail Address:  Home Phone:  Work Phone:  Mobile Phone:

READ BEFORE SIGNING

Minimum grade point average of 3.0 is required for applicants to the Graduate Program. Satisfaction of minimum requirements does not guarantee acceptance to the program. JMVU reserves the right to reject any applicant. In addition to the application, Graduate Applicants must submit the following documents: Statement of Purpose (300 words minimum) - your reasons for interest in JMVU and your field of interest, your expectations of Graduate work, and your short and long-term goals. Three Letters of Recommendation. The University reserves the right to request additional documentation as deemed necessary. All documents received become property of Jose Maria Vargas University I understand that this application is for admission to Jose Maria Vargas University. I also understand and agree that I wiil be bound by the regulations of the University concerning admissions requirements. I further agree to the release of any transcripts to this institution. I understand that this application cannot be reviewed until all requested documents and credentials have been received by the Admissions Office, and that it is my responsibility to supply these expeditlously. If admitted, I agree to comply with the regulations of JMVU and pay all required fees. I certify that the information given in this application is complete and accurate, and I understand that making false or fraudulent statements in this application may result in disciplinary action, denial of admission and invalidation of credits or degrees earned. Should any of the Information I have given change, I shall immediately notify the Admissions Office. False, misleading, inaccurate or incomplete information furnished by me on this application or any other institutional document, will be grounds for summary termination of any proceeding initiated or pending before the institution in my name and will not be subject to appeal. I hereby certify the acceptance and understanding of this agreement and voluntarily and knowingly sign this document on the date indicated below. Signature of Student Date Signature of Guardian / Legal Representative Signature of Receiving Admissions Official

OFFICIAL USE ONLY

DATE OF APPLICATION: FIRST DAY OF CLASS: LAST DAY OF CLASS: DATE PROCESSED: PROCESSED BY: