Business Executive Education Application

* indicates required field

First Name*

Middle Name

Last Name*

Email Address*

Birthdate*

Mailing Address*

Country

Street

City

Region

Postal Code

Phone Number*

Country of Citizenship*

Are you a Permanent Resident?

Yes

Social Security Number

Are you Hispanic or Latino?

Yes

Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:

Certificate Program

Please choose the certificate program to which you are applying.*

Start Term*

Education

Employment

Are you currently employed?

Position

Employer

Employer Address

Additional Information

Resume

How did you hear about our program?

Dismissed

Have you ever been dismissed from any institution of higher education or subject to any non-academic related disciplinary action? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University.)*

Dismissed

Yes

Describe in full detail*

Criminal Charges

Are there any criminal charges presently pending against you other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University.)*

Criminal Charges

Yes

Describe in full detail: Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

Conviction Charges

Have you ever been convicted, pled guilty or no contest to a crime other than a summary traffic offense? (Answering 'yes' to this question will not eliminate you from consideration for admission to the University).*

Conviction Charges

Yes

Describe in full detail: Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.*

TO BE READ BY ALL APPLICANTS

It is the policy of Duquesne University to admit those applicants who are best qualified to profit from the opportunities it offers for intellectual, spiritual and social growth. It does not discriminate on the basis of religious preference, sex, race (color), national or ethnic origin, non-performance related handicap or veteran status in the administration of its educational policies, admissions policies, scholarship and loan programs, athletic and other University-administered programs. By submitting this form I understand and agree that my continuance upon the rolls of the University, receipt of academic credits, graduation and conferring of any degree or the granting of any certificate are strictly subject to the disciplinary authority of the University, which is vested in the President, and subject to his reserved powers in the dean of each faculty.