10131 Pines Boulevard, Pembroke Pines, FL 33026

New Student Application
General Information

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Campus
First name (Primer Nombre)
Middle Name (Segundo nombre)
Last name (Apellido)
Cell Phone (Celular)
Home Phone (telefono de casa)
Email (Correo Electronico)
Birth Date (fecha de nacimiento)
Copy of Government issue ID (Copia de la identificacion del gobierno)
Please scan or upload a color picture of your state license or passport (Por favor escanee o suba una a color de foto su licencia o pasaporte)
Other Names Used, if applicable (Otros nombres usados, si aplica):
Social Security Number (Numero de Seguro Social)
This does not apply for students with or applying to an F-1 or M-1 student visa. Students with or applying to an F-1 or M-1 student visa please enter 000000000 (El numero de Seguro Social no es requerido para estudiantes que tienen o estan aplicando para una visa de estudiante F-1 o M-1. Estos estudiantes deben escribir 000000000 en el espacio)
Ethnicity (Grupo Etnico)
Gender (Sexo) Male Female
Have you ever applied to JMVU? (A aplicado a la universidad previamente?)Yes    No    Not Selected  (Required)
Are you a JMVU employee? (Es un empleado de la universidad?)Yes    No    Not Selected  (Required)
Are you a U.S. citizen? (Es un ciudadano de E.E.U.U?)Yes    No    Not Selected  (Required)
Are you a Florida resident? (Es un residente de la Florida?)Yes    No    Not Selected  (Required)
Is English your first language? (Su lenguaje principal es el Ingles?)Yes    No    Not Selected  (Required)
If no, what is your first language?  (Required)
Street (Calle)
City (Cuidad)
State/Province (Estado/Provincia)
Zip/Postcode (Codigo Postal)
Country (Pais)
Place of Birth (Lugar de nacimiento):  (Required)
Please enter city and country of Birth (Por favor incluya el pais y la cuidad donde nacio)
Nationality (Nacionalidad)
Student ID photo (Foto de carnet estudiantil)
Program (Programa) (Required)
Start date (Fecha de inicio)


Emergency Contact Information

Contact Name (Nombre de contacto)
Relationship (Relacion)
Cell Phone (Celular)
Home Phone (telefono de casa)
Work Phone (telefono del trabajo)


Employment Information

Employment Status
Job Title
Employer Name
Street Address
City (Cuidad)
State
Country (Pais)
Phone Number

Previous education information

Are you a first time college student? (Es primera vez que vienes a una institution educativa de educacion superior?)Yes    No    Not Selected  (Required)
This includes institutions attended outside the U.S.(Esto incluye instituciones universitarias fuera de Los Estados Unidos)
If no, please type the name of the institution (Si la respuesta es no, por favor escriba el nombre de la institucion)
If you don't have previous education please write N/A (Si no tienes educacion previa escribe N/A)
If no, please type the name of program completed at the prior institution (Si respondio no, por favor escriba el nombre del programa que completo en la institucion)
If you don't have previous education please write N/A (Si no tienes educacion previa escribe N/A)

Educational Informacion

Select one
Institution Name (Nombre de la Institucion)  (Required)
Please write the full name of the institution (Institution is define high school, GED, college, university or any type of postsecondary institution) (Por favor escriba el nombre completo de la institucion) (Institucion se define como High school, GED, Universidad o cualquier tipo de institucion de educacion superior)
Graduation Date (Fecha de graduacion)  (Required)
What type of education did you obtain? (Que tipo de educacion obtuvo)
Please choose the type of education completed (Por favor escoja el tipo de educacion que completo)
Cumulative GPA  (Required)
Foreign graduates or international students please enter zero (0) in this field (Los estudiantes de passes fuera de estados unidos por favor introduced el numero zero (0)
State or Country were education was completed? (Estado o Pais en donde completo su educacion)  (Required)

Judicial Information

Have you ever had any professional license revoked, suspended, or had any disciplinary action taken against you by a professional regulating body?Yes    No    Not Selected
This questions is only required for Master degree applicants.
Have you ever been charged with or subject to disciplinary action for scholastic or any type of misconduct at any educational institution?Yes    No    Not Selected  (Required)
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.
Have you ever been charged with a criminal violation before any forum?Yes    No    Not Selected  (Required)
Do you have any administrative or criminal actions pending before any forum?Yes    No    Not Selected  (Required)
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    Not Selected  (Required)

Foreign student Info (Only for international students)

Foreign cell phone
Out of U.S.A cell (Please include country code)
Foreign work phone
Out of U.S.A work
Foreign home phone
Out of U.S.A number
Foreign Street
FOREIGN ADDRESS FOR INTERNATIONAL STUDENTS
Foreign State/Province
Foreign City
Foreign Zip/Postal Code
Country (Pais)

Admissions Application Student Signature

Date(fecha)  (Required)
Student Signature (Firma)  (Required)
Guardian Signature (Firma de Guardian)
For applicants under the age of 18 (Para estudiantes menores de 18)


I understand that this application is for admission to José Mana Vargas University. I also understand and agree that I will be bound by the regulations of the University concerning admissions requirements. I further agree to the release of any transcript to this institution. 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 Office of Admissions.


Enter the above code (Introdusca el codigo)
 Required