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Application for Admission - Undergraduate

All Undergraduate Applicants who apply by August 2nd will be eligible for a 20% Tuition Grant.

Galen University is committed to the principles of equal opportunity in education. The University does not discriminate against individuals on the basis of race, color, sex, sexual orientation, religion, disability, age, ancestry, or national or ethnic origin in the administration of its educational policies, admission policies, employment policies, and other University administered programs and activities.

* Semester *
* Specify Year (e.g. 2014) *
* Last Name *
* First Name *
* I am entering as (Check all that apply): *  
* For which Undergraduate Degree Program *
* Email address *
* Permanent Home Address *
* Cell # *
* Home # *
Other #
* Date of Birth (MMDDYYYY) *
* Place of Birth *
* Gender *   
* Nationality *
* Country of Residence *
* Country of Origin *
* Primary Language *
II. APPLICATION INFORMATION Please indicate the source(s) and reason(s) that led you to apply to Galen University
* Sources *  
* Reasons *  
III. CERTIFICATION I have read, understand and agree to comply with Galen University application instructions. I certify that the information in this application and associated materials is current, complete, and accurate to the best of my knowledge. I understand that withholding information requested in the application or giving false information may make me ineligible for admission to or continuation in Galen University.
Confirmation Code
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