Online Undergraduate Application Checklist Online Undergraduate Application for Admission Save my progress and resume later | Resume a previously saved formResume LaterIn order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Page 1Online Undergraduate Application for AdmissionPlease complete this Application if it is your intent to take Multnomah classes solely in an online format.If you plan to take classes both in residence (i.e., on campus in Portland or Reno) and online, please complete the standard Undergraduate Application for Admission form. Admission forPlease select...October 2018 (Fall Semester, B Session)January 2019 (Spring Semester, A Session) CampusOnline Desired MajorPlease select...Applied PsychologyBiblical and Theological StudiesBusiness ManagementHealthcare ManagementInformation Technology - CybersecurityInformation Technology - Application DevelopmentUndecided Name First Name Middle Name Last Name Preferred First Name (If Different) E-mail Cell Phone Home Phone Allow Text MessagesAllowDo Not Allow Mailing Address CityPlease select...AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWYAPO Central & South AmericasAPO Europe, Mid-East, AfricaAPO Pacific, Indian OceanAmerican SomoaDistrict of ColumbiaFederated States of MicronesiaGuamPalauVirgin IslandsOutside the US State Zip CodeHidden Fields Student (Record Type) Constituent (Record Type) Household (Record Type) Educational Institution (Record Type)Page 2Additional Personal Information Are you a U.S. Citizen?YesNo Are you a U.S. Permanent Resident?YesNoAn international student is one who will be attending a university in the United States without residency or citizenship, typically on an F-1 visa. International students have additional application requirements as part of the Visa application process, often including an English language proficiency exam and transcript evaluation by an evaluation service. The admissions department can assist with questions about this process. Country of CitizenshipPlease select...United States of AmericaCanadaAfghanistanAlbaniaAlgeriaAndorraAngolaAntiguaArgentinaArubaAustriaAustraliaAzoresBahamasBahrainBalearic IslandsBangladeshBarbadosBelgiumBelizeBeninBermudaBhutanBoliviaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanal ZoneCanary IslandsCape Verde IslandsCayman IslandsCentral African RepublicChadChilePeoples' Republic of ChinaColombiaComoro IslandsCongoCook IslandsCorsicaCosta RicaCote d'IvoireCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEstoniaEthiopiaEast TimorFaroe IslandsFiji IslandsFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuinea-BissauGuineaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKoreaKuwaitLaosLatviaLebanonLeeward IslandsLesothoLiberiaLibyaLiechtensteinLithuaniaLaosLuxembourgMacaoRepublic of MacedoniaMadeira IslandsMalagasyMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMexicoFederated States MicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherland AntillesNetherlandsNevisNew BritainNew CaledoniaNew HebridesNew ZealandNicaraguaNigerNigeriaNorth KoreaNorthern IrelandNorwayOkinawaPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPrincipeQatarReunion IslandsRomaniaRussiaRwandaRyukyu IslandsSaudi ArabiaSouth AfricaScotlandSenegalSeychelles IslandsSierra LeoneSikkimSingaporeSouth KoreaSlovakiaSloveniaSolomon IslandsSomoliaSpainSpanish North AfricaSpanish SaharaSri LankaSanta Cruz IslandsSt. KittsSt. LuciaSt. ThomasSt. VincentSudanSultanate of OmanSurinameSouthwest AfricaSwazilandSwedenSwitzerlandSouth YemenSyriaTaiwanTanzaniaThailandTobagoTogoTongaTrinidadTurks IslandTunisiaTurkeyTuvaluUgandaUnited KingdomUkraineUnited Arab EmiratesUruguayVatican CityVenezuelaVietnamVirgin IslandsWalesWindward IslandsWestern SamoaYemenYugoslaviaZaireZambiaZimbabwe Date of Birth GenderFemaleMale Do you plan to apply for financial aid?YesNo Are you an honorably discharged veteran of active duty in any branch of the US Armed Forces?YesNoCurrently Service Do you have special needs that Multnomah should be aware of to help you succeed?YesNoInformation shared here is confidential and will not be a factor in your admission decision Please help us understandEthnic & Racial Information (Optional) Are you Hispanic/Latino?YesNoOptional - this information will not be a factor in your admission decision Please select one or more of the following races:American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite or CaucasianOptional - this information will not be a factor in your admission decisionHousehold Will you be 21 or older when you begin your first semester?YesNo Marital StatusPlease select...SingleMarriedSeparatedDivorcedWidow/WidowerParent, Guardian or Spouse InformationStudents under the age of 21 are asked to provide information about their parents or guardians Relationship to youPlease select...MotherFatherGuardianSpouse First Name Last Name Phone EmailPlease note: This email address should not match the email given for other individuals on this application. Entering the same email address as the applicant or other individuals on this form may result in a technical error. Does this person share your mailing address?YesNo Mailing Address CityPlease select...AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWYAPO Central & South AmericasAPO Europe, Mid-East, AfricaAPO Pacific, Indian OceanAmerican SomoaDistrict of ColumbiaFederated States of MicronesiaGuamPalauVirgin IslandsOutside the US State Zip CodePage 3Academic History High School Year of high school graduationPlease select...2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950 High School Name City StatePlease select...AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWYAPO Central & South AmericasAPO Europe, Mid-East, AfricaAPO Pacific, Indian OceanAmerican SomoaDistrict of ColumbiaFederated States of MicronesiaGuamPalauVirgin IslandsOutside the US Are you or will you be a home school graduate?YesNo Have you received, or will you receive, a GED?YesNo SAT & ACT I have taken or plan to take the SATI have taken or plan to take the ACTTest scores are not required for admission, but may help you qualify for an academic scholarship. Please note that SAT or ACT scores are an admission requirement for home school graduatesCollege Have you attended college or university?YesNoPlease list every post-secondary institution you have attended or are currently attending. Failure to list all institutions you have attended may result in denial or revocation of admission or disciplinary action. Please list institutions beginning with the most recent. Use the "Add Another Institution" button to enter information for more than one college. Institution Name City StatePlease select...AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVTWAWIWVWYAPO Central & South AmericasAPO Europe, Mid-East, AfricaAPO Pacific, Indian OceanAmerican SomoaDistrict of ColumbiaFederated States of MicronesiaGuamPalauVirgin IslandsOutside the US Attended from: Attended to: Are you currently enrolled at this institution?YesNo Approximate Credits EarnedPage 4Lifestyle & Background Have you used illegal substances within the last year?YesNo If yes, please provide an explanation Have you pled guilty (or no contest), been adjudicated, or otherwise been convicted of a crime or subject to a civil indictment or other disciplinary action? YesNo Do not include infractions such as speeding tickets. Please explainPlease note that offers of admission may be revoked should additional information arise that indicates unlawful or unethical behavior.Criminal or Disciplinary Disclosure & Authorization to Release InformationBecause you indicated that you have a civil or criminal indictment, conviction, history and/or disciplinary action on this application, you will be asked to complete a background check once all of your application materials are received and processed.A previous disciplinary action, conviction, indictment or prosecution may not automatically bar an applicant from admissions to the university. We request that the applicant provide the Admissions Office permission to obtain a background check (at no cost to the student). By electronically signing below, the applicant authorizes Multnomah University to have complete access to pertinent educational, employment, criminal and civil information and records: Name: Date Signed: Please provide a complete and detailed explanation regarding any civil or criminal indictment, conviction, history and/or disciplinary action: Multnomah's Doctrinal StatementMultnomah University welcomes students from a variety of denominational backgrounds. The University holds to a short list of doctrinal articles. Though it does not require students to be in agreement with all points, it is important that you be familiar with the university’s doctrinal statement, found at www.multnomah.edu/about/doctrinal-statement. I am a ChristianYesNo I have read Multnomah's doctrinal statement and I am comfortable studying at an institution that holds to these positions.YesNo If not, please explain.Church Involvement Do you attend a church?YesNo What is the name of the church you attend? City, State DenominationPlease select...NondenominationalApostolic or New ApostolicAssemblies of GodBaptistBorn AgainCatholicCharismaticChurch of ChristChurch of GodChurch of the BrethrenChurch of the NazareneCongregational/United Church of ChristDisciples of ChristEpiscopalian/AnglicanEvangelicalFoursquare GospelFundamentalistHolinessIndependent Christian ChurchLutheranMennoniteMethodist / WesleyanOrthodox (Eastern)PentecostalPresbyterianProtestantQuakerReformedOtherAcademic or Professional ReferenceMultnomah requires the submission of one Academic or Professional Reference form for the Undergraduate Online Program.You may not use a family member as your reference.Please provide the name and contact information for the individual you intend to use as a reference. By submitting this application for admission, you are waiving your right to see the reference form that is submitted on your behalf. If you provide an email address for your reference below, the Admissions Office will email him or her a link to the online reference form. Name First Name Last Name Phone EmailPlease note: This email address should not match the email given for other individuals on this application. Entering the same email address as the applicant or other individuals on this form may result in a technical error. Relationship to youPlease select...Academic or Professional ReferencePlease note: In some circumstances, we may ask for an additional reference. If this is the case, your admissions counselor will let you know and request the additional information. Reference AuthorizationBy providing this information I am authorizing Multnomah to contact the person listed above as my reference. I understand that the information provided by my reference will be used as part of the admission decision process, and I waive my right to review this information.Decision Factors How did you first hear about Multnomah?Please select...AlumniAdmissions CounselorCollege FairCo-worker or EmployerCurrent MU StudentFriendGuidance Counselor or TeacherGoogle SearchMU Faculty or StaffParent or RelativePastorRadioVisit to my high schoolWeb advertisementOther Explain What is the primary factor influencing your decision to apply?Please select...Academic Programs OfferedAcademic ReputationAdmissions CounselorAlumniBeliefs/ValuesCampus EventCampus VisitClassmateCollege FairCo-worker or EmployerFriendGuidance CounselorLocationMail or email communicationMU Faculty or StaffOther Explain Name of the person who referred you (so we can thank them)Certification & Authorization By submitting this application, I certify that I have provided complete and accurate statements on this application, and I waive my right to see reference forms that are submitted on my behalf. I understand that if it is found to be otherwise, this may be cause for rejection or dismissal. I understand that it is my right to be aware of the policies within the Student Handbook; I have read the Student Handbook and agree to respect by the policies, community standards, and values therein, as will be my responsibility as a student of Multnomah University.YesNoLinks:Mission StatementStudent Life Handbook Please type your full name in this box as a signature certifying the preceding statements are accurate and complete, to the best of your knowledge. Save my progress and resume later | Resume a previously saved form Need assistance with this form?
