MUW Office of Admissions
Office 662-329-7106
Toll Free 877-462-8439
admissions@muw.edu
 

Executive Certification

Select One: Faculty Staff Other
 
I plan to enter MUW:
   
Program of Interest
 
* INDICATES REQUIRED FIELD.
   
  PERSONAL INFORMATION
 
* First Name M.I. * Last Name
 
Preferred Name Home
Phone:
 
* Maiiling Address Mobile
Phone:
 
* City * State
 
* Zip * County:
 
* Date of Birth:
(MM/DD/YYYY)		 * Gender:
Male Female
* SSN: * Email Address
   
 
* U.S. Citizenship  
 
If not, country/countries of citiznship & birth. Visa Type
   
 
* Are you Hispanic or Latino? Yes No
 
Race & Ethnic Group American Indian/Alaskan Native Black/African American
  Asian White
  Native Hawaiian or other Pacific Islander  
       
 
Have you ever studied under another name? Yes No Name
   
 
 List all Colleges Attended
 
Schools/Colleges Attended:
(Include addresses)		 # Years Year Grad Degree
 
 
APPLICANTS STATEMENT
All Applicants Must Read And Acknowledge The Following To Complete The Application.
 
* I acknowledge that I am the applicant identified in Section 1 of this Application for Enrollment and that I have read and understand the above statement.