Professional Documents
Culture Documents
Garibaldi Square
Permanent Address Bulding 6 Interior D
Will your Spouse or Dependents require an I-20? (List Dependent s and Passport ☐ Yes X No
Number)
Name & Relationship Passport Number
Name & Relationship Passport Number
Name & Relationship Passport Number
Please attach Passports for all dependents
Family Information
Father’s Name Occupation
Address
Please print name and phone number of a contact person in your home country and/or in the U.S.
US Contact: (Required) Name
Phone
Undergraduate Programs
Undergraduate programs are offered Fall I only
☐ Bachelor of Arts in Management ☐ Bachelor of Science in Health Science
☐ General Management ☐ Health Education
☐ Entrepreneurship ☐ Health Services Administration
☐ Human Resources ☐ Gerontology
☐ Marketing
Graduate Programs- These are a twice a month weekend/hybrid schedule
X Master of Business Administration ☐Master of Science in Health Science- Specialization in Health Care Administration
English Proficiency
Spanish
Is English your First Language? ☐ Yes X No If No, what is your Native Language? ___________________________________
How many years have you studied English in the past five years?
1 year____________________________
To the best of your knowledge are you now in good physical and mental health? Yes
Personal Statement – explaining why you wish to study your chosen postgraduate course
In this way, I acquire more knowledge and I learn the English language at the same time.
Are you a high school (secondary) graduate? X Yes ☐ No If “Yes,” list date of graduation 20/05/1982
In chronological order, list any secondary schools and colleges or universities that you have attended either in the U.S. or in
another country. If you attended more than two schools, give the necessary information on a separate page. You must provide
a diploma or other proof of graduation from a secondary school as well as copies of transcripts (with an English translation)
from any college or university that you have attended. Originals will be validated when you report for orientation.
College Name
Location
Dates Attended
Major
Diploma/Degree Received
College Name
Location
Dates Attended
Major
Diploma/Degree Received
List any additional schools and colleges on a separate sheet if needed.
Professional Experience
List professional experience relevant to your program starting with the most recent first.
Employer Construcciones Lague SA de CV
Location Puebla, Pue., México
Dates Employed 2008-2018
Job Title General counter
Employer
Location
Dates Employed
Job Title
List any additional employers on a separate sheet if needed.