Regional Center Graduate Application

                                                                 Application Instructions

* Complete every question. Required fields are marked with *.

* Use the tab key or mouse to move through the fields.

* The form will automatically save when you move on to another tab by pressing the Next button.

* A  on the sidebar indicates that all required information has been completed for that page.

* Once you submit your application, you will no longer have access to it.

* Please submit a ticket through https://issrs.campbellsville.edu/ if you are experiencing any issues with the application.

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Regional Center Graduate Application

First Name:

Last Name:

Middle Name

Prefix:

Preferred Name:

Please only use numbers, do not use a + sign.

Mobile Phone Number:

Email Address:

Confirm Email Address:

Regional Center Graduate Application

Are you a citizen of the United States?

Do you currently reside in the United States?

Social Security Number:

Gender:

Date of Birth:

Religion:

Marital Status:

Ethnicity:

Race:

African American (Black) - A person having origins in any of the black racial groups of Africa. 

American Indian or Alaskan Native - A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment.

Asian - A person having origins in any of the original peoples of the Far East, SoutheastAsia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Native Hawaiian or Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Regional Center Graduate Application

Country:

Address:

City:

State:

ZIP/Postal Code:

Regional Center Graduate Application

What location would you like to attend?

When would you like to begin your studies?

What term?

What program?

Preferred residency location:

*For CU Louisville International Graduate Business Programs

**MSCS Students may be required to take Foundation courses at the discretion of CU for an additional cost**

***The PMBA (regardless of the track chosen) and MML programs are not STEM programs***

Your attendance at Residency is required each semester for the duration of the program. Residencies are two-day sessions that take place on weekends in Louisville, KY. 

Regional Center Graduate Application

Enter the information needed and press the Add button, the information will show up in the table below. If you need to add another entry you may press the Add button again. To update any entry you can do so by clicking on the Update button and once you are finished you can save it by clicking on the Add button. You can also view the entry details if available by pressing the Details button.

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State of Institution:

Name of Institution:

Degree:

Regional Center Graduate Application

Country of Citizenship: *

Country of Birth: *

City of Birth: *

Do you have a current VISA?

Please select one:

VISA Expiration Date:

SEVIS ID:

Do you have any dependents? 

Select the number of dependents:

Are you working with an agency/recruiter in your home country?

Recruiter/Agency Name:

Recruiter's Contact Last Name:

Recruiter's Contact First Name:

Recruiter's Contact Phone Number:

Recruiter's Contact Email Address:

Regional Center Graduate Application

Have you ever been convicted of a felony?

Please explain:

Verify your application is complete

Each tab on the left side of the screen should have a  next to it to indicate you have supplied all the required information. You will not be able to submit your application unless EVERY tab has a . You can go back to the page now and complete the required information, or log back in later and retrieve the application using the email and password you created when you started.

Certify your statements

I hereby certify that the above statements are true and correct to the best of my knowledge. I hereby submit this application for admission to Campbellsville University subject to the policies and procedures of the university.

By checking the box, you are granting full permission to Campbellsville University staff to request, purchase and acquire official transcripts on your behalf when possible.  This service is provided to ensure timeliness and integrity in the transcript acquisition process.  If, at any time, you wish to revoke this permission, please notify the Campbellsville University enrollment office.

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