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ADMISSIONS APPLICATION

Select a start date: *

Program of interest: *

First name *

Middle name

Last name *

Gender *

Female

Male

Undisclosed

Date of Birth (MM/DD/YYYY) * +

Do you have educational records under any other name? *

Yes

No

Other Names

0/255 characters

Email address *

Primary phone *

Secondary phone

Street address *

0/255 characters

City *

State/Province

Zip/postal code

Country *

English is my first language. *

Yes

No

How will you meet the English language requirement?

I will submit a qualifying TOEFL score to meet the English language proficiency requirement.

I have earned a BA/BS or higher degree from an accredited school in the U.S.

Are you a U.S. citizen? *

Yes

No

US Permanent Resident

Are you a veteran of the United States military? *

Yes

No

Choose all payment options you intend to utilize:

Employer reimbursement	Federal financial aid/loan
Veteran's Assistance/G.I. Bill	Self-pay

How did you hear about us? *

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QUALIFYING EDUCATION

Where did you receive your Bachelor's degree?

Where did you receive your Master's degree?

University/College

Major

Degree

NOTICE OF NONDISCRIMINATION

A.T. Still University (ATSU) does not discriminate on the basis of race, color, religion, ethnicity, national origin, sex (including pregnancy), gender, sexual orientation, gender identity, age, disability, or veteran status in admission or access to, or treatment or employment in its programs and activities. Dating violence, domestic violence, sexual assault (e.g., non-consensual sexual contact/intercourse), stalking, harassment, and retaliation are forms of discrimination prohibited by ATSU. Any person with questions concerning ATSU's nondiscrimination policies is directed to contact:

• Missouri campus – Lori Haxton, Vice President for Student Affairs (660.626.2236; lhaxton@atsu.edu), 800 W. Jefferson St., Kirksville, MO 63501

• Arizona campus – Beth Poppre, Associate Vice President for Student Affairs (480.219.6026; bpoppre@atsu.edu), 5850 E. Still Circle, Mesa, AZ 85206

Any person with questions concerning ATSU's Title IX compliance is directed to contact:

• Joe Vincent, Title IX Coordinator (660.626.2113; jvincent@atsu.edu), 800 West Jefferson St., Kirksville, MO 63501

In compliance with the Clery Act and Section 86 of DOE regulations, the University makes available to all prospective students, admitted students, and current students: ATSU's Annual Security and Fire Safety Report (ASR) and Drug and Alcohol Abuse Prevention Program (DAAPP). The ASR may be found online at atsu.edu/asr or atsu.edu/security. The DAAPP may be found online at atsu.edu/daapp. Printed copies for each report may be requested from mostudentaffairs@atsu.edu.

Please note: All communications via email, video conferences, and/or telephone may be monitored or recorded for quality assurance and training purposes.

NON-REFUNDABLE APPLICATION FEE

Application fee (US $70.00) *

I, as the credit card holder referenced above, agree to pay the non-refundable U.S. $70 application fee to A.T. Still University. I understand that all admission requirements, including supporting documents, must be satisfied before being accepted into CGHS programs.