Application for Graduate Study Related Files: Application Instructions  |  Policy on Equal Opportunity Application Fee (Non-refundable): $45.00

For Office Use Only  |      |      |     |       |       |       | IDENTIFICATION NUMBER

PRINT OR TYPE

(Use codes where indicated)

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SOCIAL SECURITY NUMBER:
_________/______/__________

Application for (semester and year)
Fall 20__   Spring 20__   Summer 20__

Date of birth
______/______/______
Month /   Day  /   Year

Gender (optional)  [     ]  Male      [     ] Female

Legal name   [     ] Mr.     [     ] Ms. 

Name:_________________________ Last (family or surname) name

___________________ First name

_____________________ Middle

_______________________ Previous last name(s)

Permanent address:_______________________________________________________________________________________
Number and street

City: _________________________ State/Country: ______________________ Zip code: _________________________

Mailing address: ________________________________________________________________________________________
Number and Street

City: _________________________ State/Country: ______________________ Zip code: _________________________

Day phone no.: (____)  _____- ________  Home phone no.:  (____)  _____- ________  E-Mail address:__________________

Fax no.:  (____)  _____- ________

[     ] U.S. citizen [     ] Permanent resident	Citizenship [__________] U.S. State or Country	Birthplace [__________] U.S. State or Country	[    ] VISA___Type
Are you a veteran of the U.S. Uniformed Services?      [     ] Yes                   [     ] No                During Vietnam [     ]

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College/School [__________] C Codes	Major [__________] C Codes	Degree sought [__________] D Codes	Indicate specific program within the department ______________________________
Classification:   [     ] Regular        [     ] Unclassified (non-degree) Status: [     ] New entrant     [     ] Transfer     [     ] FSR (Former student returning)
Enrollment:   [     ] Fulltime        [     ] Part Time

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List all universities and colleges attended. List institutions where highest degree was obtained first.
Howard University students: List Howard University and all other institutions.

Institution	City	State	Country	Major	Degree received	Dates
						From Mo/Yr	To Mo/Yr
Have you previously applied for admission to Howard University?    [     ]  Yes     [     ]  No If Yes, for which semester was last application submitted:  Fall 20 ______      Spring 20 _____     Summer 20 _____
Former Howard University students indicate last semester enrolled:    Fall 20 _____    Spring 20 ____   Summer 20 ____
Howard University school/college in which you were last enrolled: C Codes[__________] Major C Codes[________] Howard University identification number (ID): ____________________

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NAME UNDER WHICH YOU LAST ATTENDED HOWARD UNIVERSITY IF DIFFERENT FROM NAME
PRESENTLY USED.

__________________________________________________________
Last

___________________________________________________________
First

_______
MI

If you answer yes to any of the next four (4) questions, attach a letter explaining details.

a)  Have you been arrested? [    ] Yes [    ] No
b)  Have you been convicted of any crime ( other than traffic violations ) or been sentenced to a correctional or penal Institution? [    ] Yes [    ] No
c)  Has disciplinary action been taken against you at any educational institution? [    ] Yes [    ] No
d)  Has academic action been taken against you at any educational institution attended? [    ] Yes [    ] No

What most influenced your decision to attend Howard University?  E Codes[__________]

List family members (exclude spouse) who have attended Howard University. (optional)

____________________________________________________________ Name	_____________________________________________________ Relation	________________ Class of
____________________________________________________________ Name	_____________________________________________________ Relation	________________ Class of
____________________________________________________________ Name	_____________________________________________________ Relation	________________ Class of

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As indicated by my signature, I understand that withholding information required on this application or giving false information may make me ineligible for admission to the University or subject to dismissal when the same is made known regardless of classification. With this understanding, I certify that all of the above statements and information included are correct and complete; and, if admitted to Howard University, I agree to abide by its policies, rules and regulations.

Signature of applicant __________________________________________________________ Date ________________________________________

Please return the completed form, $45 application fee check or money order made (payable to Howard University) and required application materials directly to:

Office of Graduate Recruitment and Admissions

Howard University

Fourth and College Streets NW

Washington, DC 20059