APPLICATION FOR GRADUATE READMISSION
The University of Memphis
Memphis, Tennessee 38152
Graduate Admissions: (901) 678-2911
FAX: (901) 678-5023

FULL LEGAL NAME: Last First Middle U.S. SOCIAL SECURITY NUMBER: (ex. 999-99-9999) DATE OF BIRTH:  01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19 Month Day Year  Sex: Female Male  Ethnic Origin: African American--Non Hispanic Asian or Pacific Islander American Indian or Alaskan Native Hispanic White  CURRENT ADDRESS: Number & Street Apartment No. City State Zip Code Country  Phone (Area Code):   Email:  ADMISSION PROGRAM INFORMATION: Last Term of Enrollment:  Preferred Term of Admission: Fall Spring Summer  Year: 20 Name (s) on University Record:  Are you seeking a degree? Yes No If yes, what Degree? International Master of Business Administration - IMBA Master of Arts - MA Master of Science - MS Master of Fine Arts - MFA Master of Public Administration - MPA Master of Arts in Teaching - MAT Master of City & Reginal Planing - MCRP Master of Music - MMu Master of Business Administration - MBA Master of Arts in Liberal Studies - MALS Education Specialist - EdS Doctor of Audiology - AuD Doctor of Education - EdD Doctor of Musical Arts - DMA Doctor of Philosophy - PhD& Major:  Accounting Anthropology Art Art History Audiology & Speech Pathology Biology Biology (MMCS) Biomedical Engineering Business Administration Chemistry City & Regional Planning Civil Engineering Clinical Nutrition Communication Communication Arts (PhD) Consumer Science & Education Counseling & Personnel Services Counseling Psychology Creative Writing Criminal Justice Earth Sciences Economics Education Educational Psychology & Res. Electrical Engineering Engineering (PhD) Engineering Technology English Geography Geological Sciences Geophysics Health Administration Higher & Adult Education History Human Movement Science Industrial & Syst. Engineering Instruction & Curr. Leadership Journalism Leadership & Policy Studies Liberal Studies Mathematical Sciences Mechanical Engineering Music Philosophy Physics Political Science Psychology Public Administration Romance Languages School Psychology Sociology Theater Women's Studies Area of concentration within that major (refer to list of available majors and concentrations):  TEST DATA (Indicate which of the following admission tests you have taken or plan to take and the date):   Score Date GRE  Verbal 01 02 03 04 05 06 07 08 09 10 11 12 /  Quantitative 01 02 03 04 05 06 07 08 09 10 11 12 /  Analytical 01 02 03 04 05 06 07 08 09 10 11 12 /  GRE Subject: 01 02 03 04 05 06 07 08 09 10 11 12 /  GMAT: Total 01 02 03 04 05 06 07 08 09 10 11 12 /  MAT:  Total 01 02 03 04 05 06 07 08 09 10 11 12 /

DO NOT WRITE IN SPACE BELOW        ________________           College          2U6  ________________           Degree           2U6  ________________           Major            2U6  ________________           Conc             2U6  ________________           Term             2U6  ________________           Req Rule        2U6  ________________           Residency       2U6  ________________           Class             2U6  ________________           Regist Type    2U6  ________________           Admit Type   2U6  ________________           Changeover     208

RESIDENCY: Students will not gain resident classification by their presence as a student in the State of Tennessee. Have you always lived in Tennessee? Yes No Why did you move to Tennessee (for example, active duty military, employment, education, etc)? Do you plan to be a full-time or part-time student? Full-time student Part-time student Are you employed? Yes No    If yes,  Full-time Part-time If employed, provide name and address of your employer:                  Place of Employment  /   /  Date of Employment City State Phone Number Are you a Citizen of the U.S.? Yes No If no, what is your country of CITIZENSHIP and your VISA type? Country VISA Type

SELECTION SERVICE CERTIFICATION All male citizens of the United States of America between the ages of eighteen (18) and twenty-six (26) must be registered with Selective Service prior to registering for classes at The University of Memphis. This requirement does not apply to veterans and others exempt by federal law. Indicate whether or not you have registered for the draft. Yes No Exempt

Pursuant to the requirements of the College and University Security Information Act, Tenn. Code Ann. section 49-7-2200, an annual report of security information and statistics is available upon request. Contact the Assistant Dean of Students, Office of Judicial Affairs, University Center, room 105, The University of Memphis, Memphis, Tennessee 38152, (901) 678-2298, to obtain any or all of this information. All other Student-Right-To-Know information is available in the Schedule of Classes each term.

I certify that none of the information on this form is false or has been withheld.  I further certify that I understand that giving false information or withholding information may make me ineligible for admission or to continue my enrollment at The University of Memphis. Signature ______________________________________________   Date: ______________

Do not Write Below This Line

STATEMENT OF PROCEDURE: All credentials become the property of the University and cannot be forwarded or returned. NOTE:   Credentials will be maintained in active files for a 12-month period. After this period, credentials will be relegated to inactive status and must be submitted again before an admissions decision can be made.

Admissions Action:  Approved: ___________     Date: _______  Not Approved: ________    Date: _______

The University of Memphis offers equal educational opportunity to all persons without regard to race, religion, sex, creed, color, national origin or disability. The University does not discriminate on these bases in recruitment and admission of students or in the operation of any of its programs and activities, as specified by federal laws and regulations. The designated coordinators for University compliance with section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 are the Vice President for Student Affairs and the Equal Employment Compliance Officer. Information in this document will be provided in alternate format upon request. The University of Memphis is an Equal Opportunity/Affirmative Action University. It is committed to education of a non-racially identifiable student body.