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IJMB Registration Form
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Address

Emergency Contact

Name
Address

Universities that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Date / Time
This application is for enrollment as:

If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.

Are you currently or have you ever been charged with or subject to disciplinary action for scholastic or any other type of misconduct at any educational institution?
Have you ever been charged with a violation of the law which resulted in, or if still pending could result in, probation, community service, a jail sentence, or the revocation or suspension of your driver’s license (including traffic violations which resulted in a fine of $200 or more?)

High School Information

High School Address

Please provide the names of people in your immediate family who have attended the University.

Name
Name

Extracurricular, Personal and Volunteer Activities

List your organizations, position, description of the activity, and hours per week of involvement.
List each, a description, the level, and number of years of involvement.
List the type of work, your role, and hours per week of involvement.
List the job, your title, description, hours per week, and dates of employment.
Click or drag a file to this area to upload.

Parent Information

The information requested below is optional, but it may assist in the review of your admission. You are strongly encouraged to complete this section.
Do you have family obligations that keep you from participating in extracurricular activities?

For Non-U.S. Citizens Only

Did you attend?
Click or drag a file to this area to upload.

Agreement

I understand that this application is for admission only for the term indicated. I agree that I am bound by the University’s regulations concerning application deadlines and admission requirements. I agree to the release of any transcripts and test scores to this institution, including any SAT, Achievement Test, and ACT score reports. I certify that this information is complete and accurate. I understand that making false or fraudulent statements within this application or residency statement will result in disciplinary action, denial of admission and invalidation of credit or degrees earned. If admitted, I agree to abide by the policies of the Board of Regents and the rules and regulations of the University. Should any information change prior to my entry into the University, I will notify the Office of Admissions. I understand that the application fee I submit with this application is a non-refundable fee.
Do you understand and agree to the terms listed above?