Department Application For Graduate Admission

DL ELPS Program Application

Instructions: Please complete this form and submit. This will initiate the application process. Applications received by Wednesday, August 31, 2005 will receive first consideration. The last day to submit your application is Monday, October 31, 2005. Once your application has been received, a representative will contact you with additional information.

Fields with a * are required.

Application Term:

Legal Name

First Name:

Middle Name:

Last Name:

Country of Citizenship:

Other Name (that may appear on academic records)

First Name:

Middle Name:

Last Name:

First Name:

Middle Name:

Last Name:

Contact Information

Address Line 1:

Address Line 2:

City:

State:

Zip:

Daytime Phone:

Home Phone:

Email:

How did you hear about us?

Technical requirements

I have access to a system that meets or exceeds the DL ELPS requirements as specified by the Technical Requirements Page

Yes No

How do you plan to pay for the program?

Personal Funds
Employer Reimbursement
Undecided

Financial Aid
Other: