Application For Admission

  

Graduate Student

 

 


Here are some application tips to assist you with completing this form.
      - You will need to finish the application in one session; unfortunately, you cannot save it and return to it later
      - Please do not use the back button while completing your application
      - After you submit your application, if you find you need to make a change or addition to this form, please just Email Us or call us (412.578.6059) and we'll take care of it right away!

 
  * Indicates required fields
 

  Candidate Information

  *Please tell us when you will start at Carlow:        
*Last Name: 
 
*First Name:
 
Middle Name: 
  Preferred Name: *Date of Birth (MM/DD/YYYY):
   
 
*Permanent U.S. Mailing Address:  
  *City:
 
State:       *Zip:    
 
County:    
 
Home Number (Area Code/Number):   Cell Phone (Area Code/Number): *Gender:   
 

  International Address (This section required for addresses outside of the United States)                                               

 
  Address:       Country:  
 

  Temporary U.S. Mailing Address: (If different from above)                                               

 
  Address:  
  City: State:   Zip:   County:    
  Temporary Until (Date):  
 

  Citizenship Information 

  Are you a U.S. Citizen? 
If you are not a U.S. citizen, are you a U.S. permanent resident (green card holder)?

 
  If no was selected for either question please give your country of Citizenship:  
 

  Voluntary Information 

  Do you identify as: 
 
Regardless of how you answered the prior question, please check all of the
following groups in which you consider yourself to be a member:



 
  Religious Affiliation: How did you hear about Carlow?  
 

  Education 

 

Please list in chronological order all colleges and universities attended. Include schools of nursing if applicable.

 
  Name of School: Location (City, state): Dates of Attendance:  Degrees received:  
  Name of School: Location (City, state): Dates of Attendance:  Degrees Received:  
  Name of School: Location (City, state): Dates of Attendance:  Degrees Received:  
  Name of School: Location (City,State): Dates of Attendance:  Degrees Received:  
  Other name(s) under which you attended other schools:
1.)       
2.)      
3.)
 
  * Do you have schooling outside of the U.S. other than study abroad?  
 
 

  Academic Programs       

  Please Select a Location:


 
  *Please Choose a Major Program of Interest:        
 

   Other Information 

 
  Education Students Only  
  Type of teaching certificate held: State Issued By:
 
 
  Nursing Students Only  
  Commonwealth of Pennsylvania Active RN License Number:
Expiration Date:
   
 
 

   Disciplinary History 

 
  *Have you ever been convicted of or pled guilty or no contest to a crime other than a summary traffic offense? 
 
 
  *Have you ever been placed on probation, suspended, or dismissed from a previous institution?
 
 
 

   Certification - Required to complete and submit your application 

 
  Please affirm the following before you submit your application.  
  Do you certify the following?

*I understand that once my application has been submitted it may NOT be altered in any way.   
 
  The electronic signature consists simply of your name, typed by you on your keyboard. The signature is your confirmation that the application you have filled out is your own work and the information is factually true. Once you type in your name and date, this will count as your electronic signature.
 
  *Name:
 
*Date:
 
 
  *Email:
   
   
       
  OFFICE OF ADMISSIONS       CARLOW UNIVERSITY         3333 FIFTH AVENUE               PITTSBURGH                   PA 15213