SCHOOL OF BUSINESS

APPLICATION FOR GRADUATE ADMISSION

All materials submitted in conjunction with an application become the property of Georgia Southwestern State University and will not be returned.

Admission requested for: (Please Check One) *
Fall (August)	Spring (Jan)	Summer (June)	Year 20

APPLICANT INFORMATION

Full Legal Name	First (given) *	Middle	Last *
Full Legal Name
Permanent Mailing Address	Street Address *		Apt No.

	City *	State *	Zip *

	County	Telephone (including Area Code) *	Email Address *

Indicate other names used on official records if different from above:	First	Middle	Last


Contact in case of emergency	Parent Spouse Guardian Other
	First	Last	Telephone (including Area Code)

	Address		Apt No.

	City	State	Zip

CITIZENSHIP *

US Citizen	Country of Citizenship (if not US)	Visa Type
Non-Resident Alien
Resident Alien (copy of green card required)

RESIDENCY STATUS *

Legal Resident of Georgia? *

Yes If yes, how long? (Years) (Months) County

No If no, legal state of residency

Have you established and maintained legal residence in Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term in which you plan to enroll?

Yes No

Have youe ever lived outside of the state of Georgia?

Yes No

If you have ever lived outside the state of Georgia and now live in Georgia, how long have you continuously lived in the state of Georgia at this time?

(Years) (Months)

Did you (or your parents if you are claimed as a dependant) file a state income tax return this past year?

Yes No If yes, in which state did you file?

MILITARY STATUS

What is your Military Status Coding?
Not Applicable
Military Active Air Force Military Active Army Military Active Coast Guard Military Active Marine	Military Actice Navy Military Veteran Military National Guard Military Reservist	Dep/Spouse Active Air Force Dep/Spouse Active Army Dep/Spouse Active Coast Guard Dep/Spouse Active Marine	Dep/Spouse Active Navy Dep/Spouse Veteran Dep/Spouse National Guard Dep/Spouse Reservist

BIOGRAPHIC INFORMATION

Birthdate *	Gender	Marital Status	Ethnic Origin: Please answer the following two questions. (optional)
Place of Birth (City, State) Social Security Number	Female Male	Single Married Divorced Widowed Separated	Are you Hispanic or Latino? Yes No What is your race? (Choose one or more.) American Indian or Alaska Native Asian Black Native Hawaiian or Pacific Islander White

**Georgia Southwestern is allowed by law to request and use the social security number according to federal and state guidelines. While you are not required to provide your Social Security number, you are encouraged to do so. Your SSN is required for financial aid, educational tax benefits, and tracking your application status through our website.**

ACADEMIC INFORMATION *

Classification: Regular Admission

Master of Business Administration

Classification: Non-Degree Admission

Not-for-Profit Certificate

Personal Development

Post Baccalaureate

Transient

List all colleges and universities you have attended or are attending, including Georgia Southwestern State University. Official transcripts are required from each institution. If you are currently enrolled, give the last expected date of enrollment.
Name of Institution	Attendance From (mm/yy)	Attendance To (mm/yy)	Degree Earned (mm/yy)

		Date taken or scheduled (mm/dd/yy)
Scores (no more than 5 years old) will be submitted from: (Not required for 2nd Master's Degree)	GMAT
	GRE
Each applicant seeking regular admission must submit acceptable scores, on the GMAT or GRE. All test scores must be requested by the student and mailed from the testing agency directly to: Georgia Southwestern State University, 800 Wheatley St. Americus, GA 31709.

I certify that all statements made in this application are complete and true. I also understand that falsification of or failure to provide information requested may result in my immediate dismissal and/or loss of all credits from the University. If my application is accepted and I become a student, I agree to abide by the published regulations of the University and the policies of the Board of Regents of the University System of Georgia.
Yes, I agree	No, I do not agree. Do not process my application	Date:

Signature ______________________________________________