Personal Information First Name:  Middle Name:  Last Name:  Maiden Name:  Email Address:  Address:  City:  State:  Zip:  Phone Number:  Gender:   Male    Female Are you a United States citizen? Yes  No If no, of what country?  How did you hear about the program? AD  TV  Fair  Friend  Mailer  Internet  Search Engine  Other  Program for which you are applying:   Associate of Arts in Business Admin  Associate of Arts in Criminal Justice Admin  Bachelor of Science in Business Admin  Bachelor of Science in Nursing  Master of Business Admin  Master of Science in Education  Doctor of Business Admin  Doctor of Philosophy in Education  Doctor of Philosophy in Business Admin Major:  Month for which you are applying:  Previous Education, Military, Employment Post Secondary Educational Background (Regardless of degree completion) Instituion Major Degree/Diploma Type/Mo./Yr. Military Service:   Yes   No  Branch:  Discharge Date:   (if applicable) Employer's Name:  Employer's Phone Number:  Employer's Address:  References Reference 1 Name Title Phone Reference 2 Name Title Phone Reference 3 Name Title Phone Financial Aid Do you plan on applying for financial aid? Yes    No Statement of Purpose Please attach a written statement of purpose (250 words) indicating why you desire to attend the University of Riverside. If admitted, I hereby grant permission for use of my name and /or photograph in publicity, publications, and/or advertising for University of Riverside. Yes No I hereby certify that the information contained in this application is accurate and complete to the best of my knowledge. If admitted to the University of Riverside, I commit to abide by all the rules and regulations of the institution, and to apply myself to study and to fulfill the course requirements to the best of my ability. I understand that all admissions materials or information submitted becomes the property of the university and are not returnable. University of Riverside does not discriminate in its admissions decisions on the basis of race, color, national origin, marital status, physical handicap, medical condition or gender. Digital Signature By checking this box I agree to these terms and that the info I've provided is truthful. I agree. Comments:

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