PERSONAL DATA

Last Name*
First Name*
Middle Name:
Street Address
Apt/Suite
City
State:
ZIP Code:
Phone(H)*
Phone(W)
Phone (C):
Email Address*
Birth Date:
Citizenship
High School Grad Year
Drivers license number
SSN
Permanent Resident Card number (if applicable)
Program Of Interest*
Desired Start Date

PRIOR EDUCATION

List all colleges/universities at which you have taken courses for credit. An official, sealed transcript documenting receipt of a bachelor’s degree from an accredited college or university is required. Please request this be sent to Wright Graduate University, Attn: Registrar 445. E Ohio St, Suite 400, Chicago, IL 60611.

Undergraduate Institution*
Location*
Undergraduate Major Areas of Study*
Degrees Earned*
Dates of Attendance*
Degree Candidate Yes
Degree Candidate No
Undergraduate Institution
Location
Major Areas of Study
Degree Candidate Yes
Degree Candidate No
Degrees Earned
Dates of Attendance
Previous Masters Education
Location
Major Areas of Study
Masters Degree Candidate Yes
Masters Degree Candidate No
Degrees Earned
Dates of Attendance
Previous Doctoral Education
Location
Major Areas of Study
Doctoral Degree Candidate Yes
Doctoral Degree Candidate No
Doctoral Degrees Earned
Doctoral Dates of Attendance

PRIOR WORK EXPERIENCE

List your previous experience (beginning with your most recent position)

Current Title/Position:*
Employer*
Dates Of Employment*
City/State*
Brief Description of Duties*
Previous Title/Position Held:*
Employer
Dates Of Employment
City/State
Brief Description of Duties
Previous Title/Position Held:
Employer
Dates of Employment
City/State
Brief Description of Duties
How did you hear about us?

DEMOGRAPHIC INFORMATION

No information provided will be used in a discriminatory manner

Place of Birth

City
State/Province
Country
First language if other than English:
Primary language spoken at home, if other than English:
US Armed Services Veteran
US Armed Services Veteran
Marital Status

In response to U.S. federal and state agencies that require demographic data, the Wright Graduate University collects information on the race and ethnicity of its students and staff. The Department of Education requires us to ask the following two questions

1. Are you Hispanic or Latino?

2. Select one or more of the following races:

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to identify

Please answer both questions. No information you provide will be used in a discriminatory manner, and racial/ethnic data are reported only in aggregate form, not by name. It is important for the university’s reporting to have as complete a picture as possible of the racial and ethnic backgrounds of its students, faculty, and staff. The university will report whatever demographic information it currently has available for you. If there is no information in SIS, you will be reported as "race/ethnicity unknown.”

SIGNATURE

I certify that all information submitted in the admission process—including the application, essays, any supplements, attestation of HS completion, and any other supporting materials—is my own work, factually true, and honestly presented. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I’ve certified be false.

Signature"
Date