Adult & Continuing Education Programs Online Application

To begin your admission process, simply fill out this form and click the submit button at the bottom of the page. All relevant information on this form must be completed before your application can be processed by Admissions.

Urbana University admits students of any race, color, and national or ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the university. It does not discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other university programs.

Biographical Data:
Name (Last, First, MI):
Maiden Name:
Street Address:
City, State, Zip:
County (i.e. Champaign):
Phone (area code - ### - ####):
Email (Required): Note: form will not be processed without a valid e-mail address
Date of Birth (mm/dd/year):
Sex:	Male Female
Married (Optional):	Yes No
Are you a U.S. citizen or legal permanent resident?:	Yes No (Country of Citizenship )
Background (Optional):	African American Asian American Native American Hispanic Caucasian-White Other
Educational Data:
High School Name:
High School City:
High School County/State:
Graduation Year:
Obtained GED?	Yes No If yes, when?
*Note: An official high school transcript or GED certificate must be received before you can be considered for admission.*
Semester You Plan to Enroll:	Fall1 (August), 20 Fall2 (October), 20 Spring1 (January), 20 Spring2 (March), 20 Summer1 (May), 20 Summer2 (June), 20
Planned Status: Most SAGE applicants will be transfer students. Those who have previously attended Urbana University are considered re-admits.
Enrollment Status: Full-time is 12 or more hours per semester.
Do you intend to apply for Financial Aid? If yes, you must complete our Financial Aid Application (Non-degree students are ineligible for Financial Aid). Employer tuition reinbursement programs are not included.	Yes No
Site you plan to attend:
Intended degree and major of study:
Have you met with a SAGE academic advisor/site director?	Yes No
Have you ever applied to Urbana University before?	Yes No If yes, when? If yes, under what name?
Have you ever been enrolled at Urbana University?	Yes No If yes, when?
Have you ever attended another college or university?	Yes (If yes, please list all schools below) No Official transcripts must be received before you can be considered for admission.
First Institution	(Leave blank if not applicable)
Name
City, State
Dates of Attendance
Degree(s) Received
Second Institution	(Leave blank if not applicable)
Name
City, State
Dates of Attendance
Degree(s) Received
Third Institution	(Leave blank if not applicable)
Name
City, State
Dates of Attendance
Degree(s) Received
Fourth Institution	(Leave blank if not applicable)
Name
City, State
Dates of Attendance
Degree(s) Received
Fifth Institution	(Leave blank if not applicable)
Name
City, State
Dates of Attendance
Degree(s) Received
Have you attended other colleges in addition to those listed in the above spaces? If yes, please provide information on each:
Employment Data:
Current Job Title:
Current Employer:
Street Address:
City, State, Zip:
Business Phone (area code - ### - ####):
Previous Employment	List the two most recent previous employers. Leave blank if not applicable.
Previous Job Title:
Dates (From - To):
Previous Employer:
City, State:
Previous Job Title:
Dates (From - To):
Previous Employer:
City, State:
Essay:
Please write a brief statement about how your work experience relates to the degree and major you plan to earn from Urbana University.

Survey:
From what source did you initially learn about Urbana University?	Co-Worker Employer Employer Education Fair College Fair Internet Friend/Family Yellow Pages/Phonebook Urbana University Alumni Urbana University Student Urbana University Faculty/Staff Transfer Counselor at Another Institution Radio Ad Newspaper Ad (If so, which one? ) Other (please list)
Submit Application:

In addition to this application for admission, required admission materials include payment of a non-refundable admission application fee, ACT/SAT scores (if under the age of 23 and have no previous college level coursework completed), official high school transcript and official transcripts from all previously attended colleges and universities. Freshmen and transfer students are required to pay a $25 application fee. Readmits, visiting, non-degree, education certificate, and post-baccalaureate applicants are required to pay a $15 application fee. Fees and transcripts should be mailed to The Office of Admissions, Urbana University, 579 College Way, Urbana OH 43078.

Your application may take a few minutes to process, please submit only once.

By submitting you are agreeing that the information in this application is correct. Any falsification is cause for immediate cancellation of this application and registration at Urbana University.

Please send comments to: webmaster@urbana.edu

Adult & Continuing Education Programs Online Application

Biographical Data:

Essay:

Survey: