All fields in bold are required.

Personal Information


 
 


 
  (Please format mm/dd/yyyy)  






Address Information
 
 

     
 


   
   

  



Integrated Postsecondary Education Data System Survey
The US Department of Education requires us to report the ethnicity and race of our students. These two optional questions permit you to self-identify your ethnicity and race. If you do not self-identify the law permits us to identify your race by observation.



If you are not Hispanic/Latino, please select one or more of the following:









Test Information
   


Enrollment Information






 

Are you an active member of the US Armed Forces?



Are you the first generation of your family to attend college/university?



I plan to pay for school with:  


Academic History
Did you (or will you) graduate from High School or did you receive your GED?




Colleges
Have you ever attended Sullivan University?

  



Comments
Comments:  


KY Resident
Are you currently a legal resident of the State of Kentucky?





Tuition Agreement
I have read and agree to the Tuition Agreement and Tuition Terms applicable to the program for which I have applied.


Disclosure Regarding Transferability of Credits
I have read and understand the Disclosure Regarding Transferability of Credits.


Computer Requirements
I have read and understand the PC Requirements for completing classes at Sullivan University Online.


Enrollment Acknowledgement Form I acknowledge receipt of a copy of Sullivan University Catalog which describes the requirements, terms and conditions of my academic program. I also acknowledge that I am responsible for knowing and abiding by the policies and procedures contained therein. The Catalog is available online at http://sullivan.edu/CampusVue/All/docs/current-catalog.pdf

I understand that I am required to know and abide by the policies and procedures expressed and contained in the Sullivan University Student Handbook and/or the Graduate Student Handbook and that I may access the handbooks online, electronically through the Student Portal. I also understand I may request and receive a printed version of the Handbook upon request to the Sullivan University Student Services office.

I acknowledge that neither Sullivan University nor any of its agents have guaranteed, promised or otherwise ensured for me any type of employment throughout or at the conclusion of my academic program. Sullivan University’s Career Services office assists graduates with resume writing, interviewing skills, etc., however, employment of any type is not guaranteed.

I acknowledge the receipt of Sullivan University’s Campus Crime Report: http://sullivan.edu/pdf/Campus-Safety-Security.pdf


E-signature
By typing my initials in the box below, I agree to the terms outlined above, and I understand that making false statements and providing incomplete information may result in the cancellation of my admissions and/or registration. I certify that the information provided in this application is true and correct.

I, , certify that I graduated from the above listed high school or have received my GED diploma.

I, , hereby voluntarily authorize Sullivan University Online to request my official transcript(s) from my educational records.

I understand that this information will remain in effect from the date it is signed until revoked by me, in writing, and delivered to Sullivan University Online.

Please note: The Global and National Commerce Act (E-Sign Act) was enacted by the US federal government in 2000, and stipulates that electronic signatures carry an identical legal enforceability to that of a handwritten signature.

Initials:
Date:


Electronic Signature Pad (Please sign your signature using your mouse)

Student Signature





Sullivan University is an equal opportunity institution and does not discriminate against persons because of race, age, religion, sex, handicap, color or national origin. Completion of related items is optional, however it will aid in the prompt processing of your application and will be used for federal, state and Affirmative Action reporting purposes.

By submitting this form, I agree that Sullivan University may call/text me, manually and/or by automated dialing system, at the telephone number or numbers I provided about educational products or services or about other products or services in which Sullivan University believes I may be interested. I understand that I am not required to consent or otherwise provide to Sullivan University my contact information or agree to be contacted as a condition of purchasing or receiving any products or services from Sullivan University.