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Partnership Application

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Email Address

Home Phone

Cell Phone

Emergency Contact Information

Please indicate the nearest relative or person to contact in case of emergency.

Relationship

First Name

Last Name

Email Address

Phone Number

Enrollment Information

Partnership Program

Current Institution Student ID #

Entrance Term

Admission Type

Intended Major

Academic Institution

School Code

Academic Institution

School Code

Academic Institution

School Code

Attended From

Attended To

Level of Study

Degree

Date Conferred or Expected

Electronic Signature and Transcript Release Authorization

Do you authorize your current institution to release your academic information to Cleveland State University?

By selecting no, you will be responsible for requesting and paying any fees for a transcript request from your current institution.

By submitting this application I certify that the information provided on this application is accurate, complete and subject to verification. I understand that all required application information will be evaluated for admission. I also understand that any misrepresentation or omission may be cause for the University to deny and cancel admission and registration, revoke financial aid, refuse posting of transfer credit and suspension from the University if discovered subsequently. I authorize for each high school, college or university I have attended to release my academic information to Cleveland State University. Please note that all Credentials submitted in support of your application become the property of Cleveland State University and will not be released under any circumstance.

Signature

Date

Partnership Application

Personal Information

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