Graduate Application

Semester of intended entry: SeptemberJanuary

Year:

Intended Academic Program of Study: AUDT – Auditing student (For applicants who are not interested in taking exams or getting grades. The intention is to observe courses for personal enrichment.)CONT – Continuing student (For applicants with a degree and are not interested in another but only want to take a few courses for personal enrichment.)MBA – Master of Science in Business AdministrationMSc – Master of Science in Development Studies

Have you previously applied to or attended Galen University? NoYes

If yes, when did you last apply and/ or enroll?

Year applied:

Last semester/year enrolled:

Student ID #:

Last:

First:

Middle:

Suffix: (Jr., Sr., if applicable)

Previous last name:

Birthdate:

What best describes your gender?: MaleFemaleTransgenderNon-ConformingPrefer not to Say

Social Security Number:

Passport Number:

Gender: MaleFemale

Nationality:

Country of Origin:

Permanent Adress

Street Address:

City/Town/Village:

District:

Current Mailing Address (If different from above, please give your current mailing address for all admission correspondence.)

Street Address:

City/Town/Village:

District:

Permanent e-mail:

Cell #:

Home #:

Do you have any learning disabilities? If yes, kindly share:

Do you have any medical conditions that may create an emergency on campus or on a University trip
(e.g. allergies, diseases, etc.)? If yes, kindly share:

Blood Type:

Emergency Contact Name:

Relation:

Emergency Contact email:

Emergency Contact Cell #:

Tertiary School completed:

Year Graduated:

Degree earned:

Major:

Cumulative GPA:

Sources: High School Counselor/TeacherFriends/FamilyGalen University student or graduateWebsiteEducation FairThe Galen HourSocial MediaRadio AdTV AdBillboardAdvertisementOther

Reasons: ReputationPossibilities to transfer to USA/UKQualifications to be attainedReasonable tuition and feesSafety/SecurityOther