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Graduate Application

Personal Information
Social Security No.
Date of Birth (MM/DD/YYYY)
* First Name
* Last Name
Middle Name
Maiden Name
* Preferred Name
* Address 1
Address 2
* City
* State
* Zip
* County of Residence
Home Phone
* Cell Phone
* Email Address
* Contact preference	Email Home Phone Cell Phone
* Are you a U.S. Citizen?	Yes No
* Are you a veteran?	Yes No
Are you a dependent of a military service member?	Yes No
* If so, do you plan to attend Lipscomb with veteran's assistance?	Yes No
Emergency Contact
* First Name
* Last Name
* Relationship	Parent Guardian Spouse Other
* Address
* City
* State
* Zip
* Phone
International Students
What is your country of citizenship?
TOEFL Score
Visa Type
Visa Number
Visa Status (please specify)
Educational Background List all colleges and universities previously attended including Lipscomb University (list most recent first) and dual enrollment. Please request transcripts from all the colleges and universities listed below. If you have not yet graduated, list your anticipated date of graduation.
* Name of Institution
* City, State
* Dates of Attendance
* Did you graduate? If so, list degree & major

Name of Institution
City, State
Dates of Attendance
Did you graduate? If so, list degree & major

Name of Institution
City, State
Dates of Attendance
Did you graduate? If so, list degree & major

Name of Institution
City, State
Dates of Attendance
Did you graduate? If so, list degree & major

* Standardized Test	GMAT GRE LSAT MAT Not Required
Score
* Date of Exam (MM/YYYY)

* Have you ever been expelled from high school or college?	Yes No
* Have you ever been convicted of any crime other than a minor traffic violation? If yes, this question is not necessarily a bar to your admission.	Yes No
If yes, please explain
Employer Information
* Employer Name
Current Position
Address
City, State, Zip
Phone
Fax
Beginning of Employment
Is this a non-profit organization?	Yes No
* Will you be employed full-time while in graduate school?	Yes No
* Will you be participating in our employee reimbursement program?	Yes No
References Please list the name and contact information of the references that are applicable to the admission requirements determined by your program. These individuals should be willing to speak of your abilities and motivation to attend Lipscomb University.
* Name
Address
City, State, Zip
Email

* Name
Address
City, State, Zip
Email

Name
Address
City, State, Zip
Email
Application Information
* College or Department of Interest:	College of Business Institute for Conflict Management College of Education Exercise and Nutrition Science Psychology and Counseling Institute for Sustainable Practice Hazelip School of Theology
From the department or college you selected above, please select your specific program of interest below. Please select only ONE program.
College of Business
Institute for Conflict Management
College of Education
Exercise and Nutrition Science
Psychology and Counseling
Institute for Sustainable Practice
Hazelip School of Theology
* Please Indicate:	New Graduate Student Returning Graduate Student-Attend No Other Institutions Transfer Graduate Student Transient (One Semester Only)
* Have you previously applied to Lipscomb Graduate Programs?	Yes No
If so, to which program did you apply?
When do you intend to begin coursework in your program of study?
* Year
* Month
* Are you interested in our graduate assistantship program?	Yes No
Referred By: Business applicants only
Optional Information The questions below are optional.
Gender
Ethnic Background
Religious Preference
How did you find out about the program?
Please give specific examples
To what other institutions have you applied?
Signature The information provided in the application is true and accurate. I agree that if I enroll I will abide by the polices, rules, regulations and financial terms in the catalog, student handbook, and/or other university publications authorize and approved by the university. Lipscomb University reserves the right to revoke admissions on the basis of misrepresentations or omissions, whether intentional or accidental, on this application.
* Full Name
* Date (MM/DD/YYYY)
IMPORTANT GRADUATE ADMISSION INFORMATION: No action will be taken on any application until the $50 application fee is received.

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Personal Information

Emergency Contact

International Students

Educational Background

Employer Information

References

Application Information

Optional Information

Signature