Note: Please accept this signed form as my official Graduate/Doctoral Reference Form to the University of Fort Lauderdale.
* = Required Fields |
| The Office of Admissions requires three references for applicants to our graduate and doctoral programs. References must be outside of family members and must have known you for at least one year. |
Students entering a business program must supply a professional reference and one of the following: academic reference, character reference, clergy reference. Students entering a ministry program must supply a clergy reference and one of the following: academic reference, character reference, professional reference. |
| * = Required Fields |
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Date of Birth |
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| Last Name * |
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Country of Citizenship |
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| Mailing Address |
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Native Language |
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Place of Birth |
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| Zip Code
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Social Security #
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| Are you a UFTL employee? |
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Gender Type |
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Yes
No |
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Male
Female |
| Are you a dependent UFTL employee? |
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Phone Number * |
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Yes
No |
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| Email Address |
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Work Number * |
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| Race/Ethnic Data:(Please select) |
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Please specify if other:
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| /// PREVIOUS EDUCATION |
| Name of High School * |
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Date Recieved MM/DD/YY*
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Diploma Received?
Yes
No |
| Mailing Address |
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If you have taken, or plan to take any of the following tests, indicate Date |
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GRE (Graduate Record Exam) |
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Date MM/DD/YY*
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GMAT (Graduate Admissions Test) |
| State |
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Date MM/DD/YY*
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| Zip Code
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LSAT (Law School Admissions Test) |
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Date MM/DD/YY*
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Other (please specify) |
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Date MM/DD/YY*
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| Planned semester of enrollment: |
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Do you expect to register as a full-time student? |
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Fall
Spring
Summer |
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Yes
No |
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Please specify your program of study: |
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| List ALL colleges and universities (last listed first) regardless of length of attendance or work completed. |
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| Have you previously registered for course work at University of Fort Lauderdale? If yes, please specify exact date of attendance: |
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Yes
No |
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Date Attended From
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Date Attended To
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| Please list any relatives who are UFTL students or alumni. |
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First Name |
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Last Name |
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| Church Affiliation |
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Address |
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| Pastor’s Name |
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City |
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State |
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Zip Code
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Do you have any physical disabilities?
Yes
No |
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| If yes, please explain>>> |
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| /// ACCEPTANCE AND SIGNATURE |
| By my signature, I agree to the conditions of this contract. I also agree that it is my responsibility to print a copy of this application for my records, complete an Enrollment Agreement and it is my responsibility to obtain a copy of the school's catalog. |
I certify that all information supplied by me in this application is correct and complete. I understand that any misrepresentation or falsification, including failure to report any college or university attendance, is sufficient cause for cancellation of enrollment and/or any credits earned from University of Fort Lauderdale. |
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