Application for Resident Graduate Admission

Application for Resident Graduate Admission
Please complete this application and all supplemental forms, and return them with a $50 application fee.
Supplemental forms vary by degree program. Visit www.Liberty.edu/ResidentGraduate for details.
Biographical Information
Name
First/Given
Mailing Address
Middle/Maiden
Last/Surname
Street Address
State/Province
City
ZIP/Postal Code
Country
Home Phone
Cell Phone*
Work Phone
*By submitting my information through this form, I agree that Liberty University and its affiliates may call and/or text me about its educational offerings
at the phone number(s) provided, including any wireless number, using an automated technology. I understand that I am not required to submit this
form or give this consent to be able to apply to or attend Liberty University.
Please select your primary phone:
Home
Cell
Work
Have you ever been convicted of a felony or misdemeanor? _____ Yes _____ No
(If you answered “Yes,” please provide a written explanation on a separate sheet of paper or by email to ResidentGraduate@liberty.edu)
Email Address
Gender:
Male
U.S. Citizen:
Female
Yes
No
Date of Birth (mm/dd/yy)
Citizenship (if other than the U.S.)
Yes
If not a U.S. Citizen, are you a legal permanent resident of the U.S.?
No
If yes, please provide your Alien Registration Number
Marital Status:
Single
Married
Widowed
Separated
Divorced
American Indian or Alaskan Native
(including all Original Peoples of the Americas)
Please select your highest level of academic achievement:
Bachelor’s degree
Doctoral degree
Master’s degree
Post-master’s degree or certificate
First professional degree (M.Div., J.D.)
Where did you first hear about The Graduate School at Liberty University?
Print advertisement
Word of mouth
Website
TV
Conference
Other____________
Please indicate how you identify yourself. (Check all that apply)
Asian (including Indian subcontinent and Philippines)
Black or African-American (including Africa or Caribbean)
Native Hawaiian or Other Pacific Islander (Original Peoples only)
White or Caucasian (including Middle Eastern)
Hispanic or Latino (including Spain)
NONDISCRIMINATION STATEMENT
Liberty University does not engage in unlawful discrimination or harassment because of race, color, religion, creed, national origin, ancestry, ethnicity, sex, marital status, disability,
age, or veteran status in its educational programs and activities. Liberty University maintains its Christian character but does not discriminate on the basis of religion, except to the
extent that applicable law respects its right to act in furtherance of its religious objectives. The university will provide reasonable academic accommodations [(434) 582-2159 or
AcademicAccommodations@liberty.edu] and reasonable physical access accommodations [(434) 592-4107 or casas@liberty.edu] to those with qualifying disabilities. The following
persons have been designated to coordinate Liberty University’s compliance with certain anti-discrimination laws:
Edwina Berryman Disability (Online Students)
luoodas@liberty.edu
Denny McHaney
Disability (Resident Students)
wdmchane@liberty.edu (434) 582-2159
Brittney Wardlaw
Title IX Coordinator (Student Conduct)
studentconduct@liberty.edu
(434) 582-2320
Laura Wallace
Title IX/Sex & Disability (Employment)
HR@liberty.edu
(434) 592-7330
Previous Education
1.
2.
3.
College(s) attended (Use additional sheets if necessary.)
Name of college/university
City
State
Last name under which you attended
Years attended
Name of college/university
City
Last name under which you attended
Years attended
Name of college/university
City
Last name under which you attended
Years attended
Degree earned
State
Degree earned
State
Degree earned
Military Information
Status:
Branch:
Active
Air Force
Reserves
Veteran
Department of Defense
Army
Coast Guard
Marines
National Guard
Navy
Academic Year and Degree Selection
Fall Term (Aug.-Dec.)
Academic Year
Spring Term (Jan.-April)
Indicate your intended degree program:_______________________________________
You may choose one degree from the list of programs at www.Liberty.edu/ResidentGraduate.
Please contact a Resident Graduate admissions counselor if you have any questions.
Summer Term (May-July)
Verify summer course availability with the academic department.
Summer enrollment may not be available to international students.
Nonrefundable Application Fee ($50)
Check/Money Order (enclosed)
Credit Card #
Security Code
Exp. Date
I have graduated from Liberty and would like to pursue another degree. Please waive my application fee.
I am a current Liberty student. Please waive my application fee.
Student ID #
Degree Completed
Statement and Signature
Year of Graduation
(Please review the application for accuracy before signing.)
An applicant applying for admission shall pay a $50 application fee. This application fee is nonrefundable and nontransferable. This fee cannot be applied toward
other university charges. The application and its fee may be deferred for one academic year.
1. The university may make such investigation as it deems proper in connection with this application, and will treat as confidential all information submitted herein
or received by the university from any source including, without limitation, the applicant or his/her family. An applicant may review any information gathered.
2. The provision concerning fixing the amount, adjustment on withdrawal or late arrival, and other terms of comprehensive fee payment as set forth in the
university’s annual catalog are incorporated herein and are hereby accepted.
3. The Graduate School Code of Honor addresses the appropriate academic and personal conduct expected of graduate students and is an integral part of the
Liberty University community. The Code of Honor, an expression of the values inherent in the university’s doctrinal statement, defines the rules and principles by
which our community functions. At the core of this code are two key concepts: a belief in the dignity of all persons and an insistence on the existence of objective
truth. Graduate students are expected to respect and uphold these standards while registered at Liberty University. All students will be required to read and
indicate compliance to the Code of Honor prior to matriculation.
I certify that the information provided on this application is complete and accurate to the best of my knowledge, and that Liberty University is authorized to make
whatever inquiries are necessary to certify the accuracy of my records. I understand that withholding or giving false information will make me ineligible for admission
or result in dismissal from Liberty University. I understand and agree that Liberty University may disclose information from my education records to appropriate
government agencies for the purpose of assisting such agencies in the administration of financial aid programs or to address matters of public health and safety.
I understand that my enrollment to the university is conditional upon agreement to the Code of Honor.
The mission of Liberty University is to develop Christ-centered men and women with the values, knowledge, and skills essential to impact the world. We expect
that our students understand and respect our mission and purpose while enrolled at Liberty University.
Signature
Date
Office of Resident Graduate Admissions
1971 University Blvd. Lynchburg, Va. 24515 | P: (877) 298-9617 | F: (434) 522-0430
ResidentGraduate@liberty.edu | www.Liberty.edu/ResidentGraduate