Faculty Application for Graduate School Admission

All faculty complete this form to be admitted to the Graduate School in order to register for courses or enroll in programs.

Name Name * First Last
Home Address Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
ENumber *
Enrollment for which semester *
Degree History
Bachelors- Name of Institution and Year Conferred
Master's- Name of Institution and Year Conferred
Doctorate or other- Name of Institution and Year Conferred
Transcripts on file with EIU

Transcripts on file with EIU Yes No
Applying for *

Applying for Non Degree Status Degree Status
If applying to a program, please list which program
Department/Office of Employment at EIU *