Application for Graduate Enrollment

Marriage and Family Therapy

Application

Application for Graduate Admission

First Name *

Middle Name

Last Name *

Address *

Phone *

Email *

Employer

Title/Occupation

Work Phone

Have you previously applied for admission to Phillips Graduate Institute *

Yes

No

If yes, under what name did you previously apply?

When do you plan to enroll in classes?

Sex *

Male

Female

Do you consider yourself Hispanic/Latino?

Ethnic Background

Marital Status

Number of dependents

Religious preference:

Citizenship *

Visa Type

Issue Date:

Have you taken TOEFL?

Yes

No

If yes, TOEFL Score

Name of College / Bachelors Degree *

Address *

Date of College Graduation *

Please list names of all college(s) and date(s) attending, starting with most recent attended *

I certify that the information herein is complete, factually accurate, and honestly completed. I understand that my admission and subsequent registration may be cancelled if this information is found to be false or intentionally omitted. If I enroll at Phillips Graduate Institute, I agree to familiarize myself with all the rules and regulations of the University and abide by them. *

Name

By providing a signature below, you are granting full permission to Phillips Graduate Institute staff to request, purchase and acquire official transcripts on your behalf. This service is provided to ensure timeliness and integrity in the transcript acquisition process. If, at any time, you wish to revoke this permission, please notify the Phillips Graduate Institute enrollment office. *

If you are human, leave this field blank.