Last Name First Name M.I. Maiden Name
STUDENT INFORMATION
A $75.00 non-refundable fee must accompany this application. Make a check or money order payable, in U.S. funds, to California Coast
University; or make a payment via credit card. Remember to include your name on your check or money order. Applicants must be at
least 18 years of age and have graduated with a high school diploma or G.E.D. certificate to be admitted to the University.
Permanent Mailing Address
Date of Birth Social Security Number E-mail - Primary E-mail - Secondary
Home Phone Work Phone/Ext. Mobile Phone Gender
oMale oFemale
Will you be using tuition assistance through any of the following? If so, please check one.
o VA Benets oCompany Reimbursement oOther ____________________________
Ethnic Heritage o African-American o American Indian/Alaska Native o Asian/Pacic Islander
(optional)
oCaucasian o Hispanic o Other ______________________________
Please select one of the following certicate or degree programs:
Application for Admission
California Coast University - 925 N. Spurgeon Street - Santa Ana, CA - 92701 - Phone: (888) CCU-UNIV - www.calcoast.edu (Rev. 3/18) Pg. 1 of 2
How did you hear about CCU? If Referred, by whom? (Please be specic)
Company/Current Employer Title
City State
Zip Code/International Postal Code Country (If not U.S.A.)
I certify that I graduated with a high school diploma or G.E.D. certicate from the institution listed below:
__________________________________________________________________________________ in the year _____________.
Print name of your high school (or agency that awarded your G.E.D.) City, State
Have you ever been in the military?
o Yes oNo
Undergraduate Degrees Graduate Degrees
o A.S. Business Administration o M.A. Organizational Leadership
o A.S. Business Marketing
o A.S. Criminal Justice o M.B.A.
o A.S. General Studies o M.B.A. Business Marketing
o A.S. Health Care Administration o M.B.A. Health Care Management
o A.S. Psychology o M.B.A. Human Resource Management
oM.B.A. Management
o B.S. Business Administration
o B.S. Business Marketing o M.Ed. Administration
o B.S. Criminal Justice o M.Ed. Curriculum and Instruction
o B.S. General Studies
o B.S. Health Care Administration
o B.S. Management
o B.S. Psychology
o M.S. Criminal Justice
M.S. Psychology
o Ed.D. Educational Administration
o Ed.D. Educational Psychology
o Ed.D. Organizational Leadership
Undergraduate Certicates
o Business Administration
o Fundamentals of Criminal Justice
o Fundamentals of Finance
o Health Care Administration
o Fundamentals of Management
o Fundamentals of Marketing
o Fundamentals of Psychology
Graduate Certicates
o Business Administration
o Curriculum and Instruction
o Educational Administration
o Health Care Management
o Human Resource Management
o Management Studies
o Marketing Studies
o Organizational Leadership
o Psychology Studies