Personal

First Name:
Middle:
Maiden Name:
Last:
Suffix:
Preferred Name:
Soc.Sec.Number:
Home E-Mail:
Phone:
Home Address:
City:
County:
State:
Zip:
Degree Program: (Check only one)	IMBA MAcc MAcc (Online) MBAMBA Plus

I wish to apply for the term beginning:	The Campus location to which I am applying: Boiling Springs Spartanburg Statesville Catawba Winston-Salem Charlotte
Spring Year:	Status: Degree SeekingSpecial Student
Summer Year:	GMAT was/will be taken :month year
Fall Year:	How did you learn about the Graduate School of Business:

Current Employment Information

Position/Title:
Company:
Address:
E-Mail:
City:
County:	State: Zip:
Phone:	Ext: Fax:

             Brief description of duties/responsibilities:
            
             Does your employer participate in a tuition reimbursement program?

            YES NO DO NOT KNOW

Undergraduate Education

Please list all universities and colleges attended

College/University	Major	Degree	Year

Graduate/Professional Education

College/University	Major	Degree	Year

Professional/Community Involvement:

List all professional or community organizations with which you are affiliated, indicating offices held and dates of involvement. Note any significant awards, achievements, or certifications.

Recommendations:

List below the individuals whom you have asked to provide recommendations in support of your application.
(Printable Forms are available on Website)

Recommendation 1

Name:
Title:
Organization:
Address:
Phone:
City:
State:	Zip:

Recommendation 2

Name:
Title:
Organization:
Address:
Phone:
City:
State:	Zip:

Recommendation 3

Name:
Title:
Organization:
Address:
Phone:
City:
State:	Zip:

Professional Goals/Expectations

In the space below, please describe your career aspirations and how your graduate business degree will relate to this achievement.
What specific benefits do you anticipate from the program? What contributions do you anticipate making to the program?

Statistical Data:

The following information is requested as statistical data for Gardner-Webb and for fulfillment of requirements of law. None of the information in this section will be evaluated for purposes of eligibility for admission. Gardner-Webb University admits students without regard to religious creed, race, sex, national origin, or handicap.

 

Date of birth:
Sex:	M F
Will you receive veteran's benefits?
Are you a U.S. citizen?
If not, what is your visa status?
What is your country of birth?
Ethnic origin:	White/Non-HispanicBlackHispanicAmerican IndianAsian/Pacific Islander
Religious Preference:
Hometown Newspaper:
Have you ever been dismissed from any School for disciplinary reasons:	Yes No
If YES, please explain:
Have you ever been convited of, or pleaded guilty to a, felony:	Yes No
If YES, please explain:
Previously enrolled in Gardner-Webb:	NoYes
If yes, semester and year:
Name under which previously enrolled:
Current marital status:	SingleMarried

                

                                                                              

STUDENT STATEMENT: By submitting this application, I certify that all the information given in this application is complete and accurate. When I attend Gardner-Webb University, I agree to abide by the established rules and regulations of the institution.