Personal Data

Campus

Anaheim LA

Entrance

New Re-Enter Transfer from orher OM school

Lastname
Firstname

Mr. Ms.  
 

Social Security Number# 

(If applicable)

Place of Birth
( City / State or Country )

Date of Birth
( Month / Day / Year )

Home Phone

      Work Phone   

Street

City

State

              Zip  

Country

*E-mail

 Please mark all applicable:
Nonresident Alien    Black, non-Hispanic    Asian/Pacific Islander     Hispanic      
American Indian/Alaskan Native     White, Non-Hispanic        Race/ethnicity unknown

In case of emergency, notify:

Lastname / Firstname
Address / City / Zip / Country
Phone Number

        Relationship   

Program

Applying for the term beginning:

Winter Spring Summer Fall    2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Course instruction language preference

Chinese English Korean

Do you plan to apply for financial aid
(student loan)?

Yes No

Educational Background

 Name of school                                                       Location                            Year                              Major                              Degree

Have you ever been convicted or pled guilty or no contest to a felony or a misdemeanor?

Yes No   

Have you ever been convicted or pled guilty or no contest to a felony or a misdemeanor in a foreign country?
(If yes, attach explanatory statement.)

Yes No   

Have you ever been dismissed from any colledge, graduate school or professional school?

(If yes, explain circumstances on a separate sheet or paper and attach to the completed application)

Yes No   

Are you requesting for any special/disability accommodation?

(If yes, submit official special/disability documentation. See regulation 6078.01R)

Yes No   

* Official transcript(s) must be mailed directry from your previous colledge(s). Transcripts with a broken seal will not be accepted. Official transcripts received at South Baylo University 90 days after matriculation date will not receive transfer credit.

* Please submit two letters of recommendation to support your application to enroll in the university.
 

Please tell us your decision in choosing SBU to study Acupunctur and Oriental Medicine

How did you hear about us? (Please be specific)

   Newspaper / Magazine        Television / Radio         Other 

   Website           Referral  (Name)           College Career and Transfer Day Event

I hereby certify that all the information provided in this application is tru and correct to the best of my knowledge. I have listed all colleges ever attended including professional schools. False information will invalidate my enrollment at SBU. If my application is accepted, I agree to pay the current tuition charges and fees. I also agree to abide by all rules and regulations of the University.
*Check this Box if you agree with the above statement: