Application Header
Program of Study:

 
Anticipated Enrollment Term:  

Required Information
Mr. Mrs. Ms.
Last Name     Maiden     First     Middle     Preferred
Mailing Address, Street, PO Box
City     County     State     Zip
Home     Cell     Work     Email
mm/dd/yy  
Social Security Number     Date of Birth    
US Citizen / Permanent Resident: Yes No  

 

Optional Information

Information in this section is not required for admission and will not be used in determining a candidate’s eligibility for admission.
Ethnic Origin Marital Status Religious Preference  Name of Church
Church Address   City   State   Zip
     
T-Shirt Size      
 
Relatives Who Have Attended University of the Cumberlands - Cumberland College
Name Relationship Dates Attended
Name Relationship Dates Attended

 
Education
High School Attended Graduation Date
City State Country

 

LIST COLLEGES YOU HAVE ATTENDED

We must receive a certified transcript with an official seal and signature from each college or university. Failure to list all institutions previously attended or in which you are currently enrolled may result in loss of credit and dismissal from the University.

Have you ever attended University of the Cumberlands?
If so, what dates? Under what name?

 

College City State Dates Attended
 
Degree Earned   Degree Type  
College City State Dates Attended
 
Degree Earned   Degree Type  
College City State Dates Attended
 
Degree Earned   Degree Type
College City State Dates Attended
 
Degree Earned   Degree Type
TRANSFER COURSES
Are you planning on transferring in Graduate Level hours from another college?
EMPLOYMENT HISTORY: List your most recent employer, briefly describing your duties.
Employer Address Dates Employed Duties

 
WHO OR WHAT INFLUENCED YOU TO APPLY TO THIS PROGRAM?

 

HOW DID YOU FIRST LEARN ABOUT UNIVERSITY OF THE CUMBERLANDS? (Please check all that apply)
Direct Mail Currently Enrolled Student Alumni
Newspaper Ad Internet Search Engine Email Ad
Radio Ad Television Community Organization
Faculty / Staff Member Friend / Relative Church
Place of Employment Teacher/Colleague EPSB
Local Resident Student Troops to Teachers
UC Website University Center of the Mountains Other:

 
CONFIDENTIAL INFORMATION
Are you currently on probation, parole, or under restriction with any court, or have you ever been convicted of a crime other than a traffic violation?
  No Yes (If yes, please provide written explanation below)


 

Has any academic or disciplinary action been taken against you at any secondary school or institution of higher learning you have attended, including University of the Cumberlands?
  No Yes (If yes, please provide written explanation below)

 
 

VERIFICATION AND SUBMISSION

I understand that, in completing my application, the Graduate Admissions Office and the corresponding academic department will receive confidential recommendations from various individuals, and I agree that I will not have access to those documents; neither will University of the Cumberlands release the same to third parties.  I hereby certify that all statements in this application are complete and true and acknowledge that my admission and continuing status at University of the Cumberlands are conditional on such completeness and truthfulness.  If accepted as a student, I pledge to uphold the Christian values which are the foundation of University of the Cumberlands.  I will conduct myself in a manner which will positively reflect upon me, my peers, and the University.  I consent to the use of my name and my picture in University media.



In order to submit your application, you must agree to the terms above.
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