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 * Required Middle Initial Last Name * Required Previous Name(s) Gender Male Female Birth Date (mm/dd/yyyy) - must be mm/dd/yyyy format * Required MM slash DD slash YYYY Last Four Digits of SSN * Required Address * 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 Title Agency * Required Previous 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 * Required 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 - must be mm/dd/yyyy format 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 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name HiddenCardholdername2 Billing Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CAPTCHA Δ
