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5000 N. Willamette Blvd., MSC #177
Portland, Oregon 97203
Phone: 503.943.7107 | Email: gradschl@up.edu
Website: www.up.edu/graduate
Graduate Non Degree Seeking Student Application
Please note the following:
Graduate non-matriculated admission and course enrollment do not imply and should not be mistaken for admission into a
graduate program at the University of Portland.
Non-matriculated graduate students cannot accumulate more than nine graduate credit hours at University of Portland. Full
graduate student admission is required for enrollment in University of Portland courses beyond those nine credit hours.
Courses taken by students in the non-matriculated status may not be applicable toward the requirements for a master’s/ doctoral
degree.
Complete the following application and return with a completed registration form, a copy of any degree awarding transcript, and a $50
application fee. If you have any question, contact the Graduate School by email at gradschl@up.edu
or by phone at
(503) 943-7107.
Enrollment for: Fall 20____ Spring 20____ Summer 20____
Name (First, Middle, Last, and Maiden): _________________________________________________________________
Social Security Number: _________________________ Student ID# (if a previous student):________________
Check the following that apply:
Male Female Other
Date of Birth: __________________________________ Place of Birth (State or Country):__________________
Country of Citizenship:___________________________ Are you a U.S. Permanent Resident? : Yes or No
Contact Information: Phone Number(s): (Home) ___________________ (Cell)___________________
Local Address (Number and Street): ____________________________________________________________________
City: ________________________ State:_______________________ Zip: ________________________
Permanent Address (Number and Street): _______________________________________________________________
City: ________________________ State:_______________________ Zip: ________________________
Email Address:______________________________________________________________________________________
Ethnicity: (optional) Are you Hispanic or Latino?
Yes No
Select one or more of the following races (optional):
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Preferred Pronouns: Please list your preferred pronouns (optional): _________________________________________
Previous colleges attended and degrees received:
Name of Institution:______________________ Major/Degree:________________ Graduation Date:______________
City:__________________ State:_________________ Dates of Attendance (Month and Year):___________________
Name of Institution:______________________ Major/Degree:________________ Graduation Date:______________
City:__________________ State:_________________ Dates of Attendance (Month and Year):___________________
Name of Institution:______________________ Major/Degree:________________ Graduation Date:______________
City:__________________ State:_________________ Dates of Attendance (Month and Year):___________________
5000 N. Willamette Blvd., MSC #177
Portland, Oregon 970203
Phone: 503.943.7107 | Email: gradschl@up.edu
Website: www.up.edu/graduate
Have you ever been dismissed, suspended, or placed on disciplinary probation by a secondary school or college?
Yes No
If yes, please explain your dismissal, suspension, or probation below:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Have you ever been arrested or convicted of any violation?
Yes No
If yes, please explain your arrest or conviction below:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
At the time of the end of your enrollment at your current college/university, or, if you are still a student, were you or are you
currently the subject of a disciplinary or student conduct charge or proceeding?
□ Yes □ No
If yes, please explain your disciplinary or student conduct charge or proceeding below:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
I certify that to the best of my knowledge, all statements I have made herein are complete and correct, and that since I have
earned a bachelor’s degree, I am eligible to enroll for graduate course work. Once I am registered for a course at University of
Portland, I acknowledge I am responsible for payment of my tuition account and related expenses by the University’s designated
due dates. If I default on payment, I agree to pay all reasonable collection costs, including attorney fees and other charges
necessary for collection of this balance.
Signature:_____________________________________
Date:_________________________________________
University of Portland does not discriminate in its educational programs, admission policies, scholarship and loan programs,
athletic and other school-administered programs, or employment on the basis of race, color, national or ethnic origin, sex,
disability, age, or sexual orientation. The University expressly reserves its rights and obligations to maintain its commitment to its
Catholic identity and the doctrines of the Catholic Church.
Approval
Signature: _____________________________________ Date: __________________________________________
Dean of the Graduate School
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Completed 1 November 2019

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