APU Off-Campus Application for Admissions and Registration Form APU Off-Campus Application for Admissions and Registration Form Step 1 of 3 33% HiddenEmail HiddenAgency Name First Name* Middle Initial Last Name* Previous Name(s) Gender Male Female Birth Date (mm/dd/yyyy)* MM slash DD slash YYYY Last Four Digits of SSN* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Email* APU Account Name (if exists) Home Phone*Work PhoneJob Title Agency* Previous Education (Check Highest Level Only)*Master'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* Yes No In addition, you may describe yourself as having origins in original peoples of American Indian or Alaska Native: North, South & Central America w/tribal affiliation or community attachment Asian: Far East, SE Asia or Indian Subcontinent Black or African American: Black racial groups of Africa Native Hawaiian or Pacific Islander: Hawaii, Guam, Samoa, & other Pac Islander White: Europe, the Middle East, or North Africa Two or more races Have you previously registered for course work taken at or through APU (previously AMU)? Yes No Last Registration Date MM slash DD slash YYYY Do you need to request accommodations from the sponsoring agency for this course? No Yes Total $0.00 HiddenOffer ID Product NameCourse ID Course Name CreditsCourse Dates Term Additional Recipient Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name HiddenCardholdername2 Billing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CAPTCHA Δ
