Graduate Application for Admission
This application must be accompanied by a non-refundable $30.00 application fee
payable to Eastern Illinois University.
Please complete application and then Print
E-mail address:
Name (last, first, m.i.):
All previous name(s):
Permanent Address:
City: State:
Zip:
Phone:
Mailing Address (if different from above):
City: State:
Zip: Phone:
Birthdate(month/day/year) (Check one) Male Female
Ethnic Origin (Response to this question will not affect the admissions decision and is optional).
This information is requested so that we may demonstrate to federal and state agencies that the institution is in compliance
with appropriate regulations.
Native Hawaiian or other Pacific Islander
American Indian or Alaskan Native Asian
Yes
No
Select one or more race.
White
Black or African American
Illinois Resident? Yes No How long?
Years
Months
U.S. Citizen Non U.S. Citizen --- Country:
Are you Hispanic or Latino?
(A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture or origin regardless of race.)
