CLO3D Training Non-Credit Application

Previous Name(s)

Primary Email

Date of Birth

Last four digits of your Social Security Number:

Current Home Address

City, State, Postal Code and Country

Primary Phone or Mobile Number

Are you a former CMU student? Yes or No

Yes No

List your current employer. If none, list NA

For reasons involving academic dishonesty, financial impropriety, or an offense that harmed or had potential to harm others.

Has any secondary school or college you have attended taken any of the following actions against you: expulsion, suspension, placed on a probationary period, other disciplinary action, or entered into an informal resolution resulting in disciplinary action with you?

Yes No

Who should select DACA/Long-term resident? Central Michigan University is committed to supporting students from all backgrounds and this includes undocumented students. Select this option if you have a permanent address in the US and none of the other statements accurately describe you.

US Citizen/US Dual Citizen

US Permanent Resident/Green card holder

US Asylee/Political Refugee

US long-term resident/DACA

Non-US resident who has or will need a Visa

Non-US resident who will remain outside the US

Please list your country of citizenship

Full Name and date below will serve as your signature

Attachments if needed.

File attachments associated with the ticket.

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Your name

Your email address

Verification Code

CLO3D Training Non-Credit Application

For reasons involving academic dishonesty, financial impropriety, or an offense that harmed or had potential to harm others.

Other Fields