Jenzabar University

Application for Admission

Name & Biograph Information

First Name

Middle Name

Last Name

Suffix

Prior Last Name(s)

Gender

Birth Date

SSN

Citizenship Information

Status

Resident Alien Registration Number

Citizen Of

Race Information

Race (Choose one or more)

Ethnicity Information

Ethnicity

Contact Information

Do you reside outside of the United States?

Please use your Mailing Address and NOT your Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

I've been a resident of Maine since

Country

Cell Phone Number

Home Phone Number

I am Willing To Receive Text Updates

(data charges may apply)

Email Address

Confirm Email Address

Enrollment Preferences

What year do you plan to begin your studies?

Applications for the following programs are accepted between September 1 and December 30 of each year, and begin yearly each fall:  Nursing, Extended (3 year) Nursing, Medical Radiography, and Extended (3 year) Medical Radiography.

Applications for the Surgical Technology program are accepted between September 1 and February 1 of each year and begin yearly each fall.

All Advanced Certificate programs require the applicant to have earned a minimum of an associate degree in order to enroll. Please see catalog for details. Online Catalog

Choose a program of study.

At which location would you like to take classes?

Please select an Entrance Type

High School Information

What level of secondary education have you obtained?

Hidden GED response

High School State

High School Name

Name of School (if not listed in the drop down menu)

Year of Graduation

Center for Technical Education (CTE) / Vocational Program Information

Did you attend a vocational program (CTE) while in high school?

Which one?

What was your vocational program of study?

How many years of vocational programming did you complete?

Prior College Information

You must disclose all prior colleges attended.  Failure to furnish all information on past education may constitute adequate reason for disqualification of your acceptance or subsequent dismissal from the College as well as possible retraction or denial of financial aid funds.

Have you attended a college or university?

State of Institution

Institution

Name of Institution (if not listed in the drop down menu)

Did you earn credits at this institution?

You MUST click the Add School button (to the right) in order to properly submit the school's name.

Parental Education Information

Please answer what best describes your mother's educational level of attainment?

Please answer what best describes your father's educational level of attainment?

Military Service/Veteran Benefits Information

Are you or your spouse, or are you a dependent of someone that is, on Active Duty, a US Veteran, receiving Veteran's Benefits, or in the Maine National Guard?

Are you currently on active duty?

For which branch of the military?

Are you a US Veteran?

For which branch of the military?

Please request your CCAF transcript at, http://www.airuniversity.af.mil/Barnes/CCAF/

Are you currently a member of the Maine National Guard?

Are you receiving veteran's benefits?

Are you a spouse or dependent of a veteran or active duty member?

Are you a spouse or dependent of a veteran who is deceased?

Are you a veteran or active duty service member who has suffered a service-related injury/illness OR are you a spouse of dependent of one who has?

Criminal History

Have you ever been convicted of a crime or adjudication other than a minor traffic offense?

Please explain the circumstances of your conviction:

On Campus Housing Interest

Are you interested in living on campus?