INSTRUCTIONS

Please provide the informaion requested. You may submit this application in person, by mail, by fax or submit online. Admission is granted without regard to race, gender, handicap or nationality.

Last Name
First Name
Address
Home Telephone
Work Telephone
Email
Fax
Birthplace
Planned Program Start Date
Birth Date	Month		Day		Year
Sex		Male		Female

Degree Objective
A.A.	B.B.A.	M.B.A.	M.P.A.	MED	MCS	Certificate

EDUCATIONAL INSTITUTIONS ATTENDED

List in order, (first to last) all educational institutions you have attended or are attending. Begin with elementary school, junior high school, senior high, college or university, give exact dates of attendance, and the name of each degree/diploma/certificate awarded in English.

Name of Institution	City & Country	From To		Name of Certificate or Degree Awarded

I hereby certify that all statements made hereon are true and correct to the best of my knowledge and authorize the vertification of all statements herein recorded by California American University in processing my application.

I also authorize California American University to release this information to any credit evaluation agency it deems necessary in completing my application.