APU Off-Campus Application for Admissions and Registration Form APU Off-Campus Application for Admissions and Registration Form Step 1 of 3 33% Email Agency NameFirst Name * RequiredMiddle InitialLast Name * RequiredPrevious Name(s)GenderMaleFemaleOther Other Birth Date (mm/dd/yyyy) - must be mm/dd/yyyy format * Required Date Format: MM slash DD slash YYYY Last Four Digits of SSN * RequiredAddress * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Email * Required APU Account Name (if exists)Home Phone * RequiredWork PhoneJob TitleAgency * RequiredPrevious Education (Check Highest Level Only) * RequiredMaster's Degree or HigherBA / BS, have taken graduate coursesBA / BS, have NOT taken graduate coursesAttended a 4-year college or universityAssociate Degree or RN DiplomaAttended a 2-year collegeGED High School Diploma, have never attendedHigh School Diploma, have never attended a college or universityDo NOT have a High School DiplomaDo you consider yourself to be Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race * RequiredYesNoIn addition, you may describe yourself as having origins in original peoples ofAmerican Indian or Alaska Native: North, South & Central America w/tribal affiliation or community attachmentAsian: Far East, SE Asia or Indian SubcontinentBlack or African American: Black racial groups of AfricaNative Hawaiian or Pacific Islander: Hawaii, Guam, Samoa, & other Pac IslanderWhite: Europe, the Middle East, or North AfricaTwo or more racesHave you previously registered for course work taken at or through APU (previously AMU)?YesNoLast Registration Date - must be mm/dd/yyyy format Date Format: MM slash DD slash YYYY Do you need to request accommodations from the sponsoring agency for this course?NoYes Total $0.00 Offer IDProduct NameCourse IDCourse NameCreditsCourse DatesTermAdditional Recipient Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Billing Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
