Entrepreneurship Certificate Program Admission Form

Page 1

DEPARTMENT OF BUSINESS ADMINISTRATION

EWC ENTREPRENEURAL WORKSHOP SERIES WITH

U.S. SMALL BUSINESS ADMINISTRATION (SBA) Application for Admission Form APPLICANT INFORMATION

Last Name:

STUDENT #:

M.I.:

First Name:

Street Address:

Apartment #:

City:

State:

Email:

Male

Phone #:

ZIP: Female

Why did you choose to participate on the Entrepreneurship Workshop Series?

HIGHEST EDUCATION

High School

Yes

N0

Bachelor Yes

N0

EWC STUDENT

Yes

CLASSIFICATION

Freshman Sophomore Computer Information Systems

Masters Yes

N0

Doctorate Yes

N0 Junior

Senior

DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. Even if this application is accepted, I understand that false or misleading information in my application may result in cancellation of admission. Return Form to: fikeokwu@ewc.edu

Phone: (904) 470-8134 or (904) 470-8133

Date

Signature of Applicant:

OFFICE USE ONLY – DO NOT WRITE BELOW Decision Application Accepted

Yes

N0

Application Deferred

Yes

N0

Application Denied

Yes

N0

Signature of Chairman: Dr. Francis Ikeokwu, Sr.

Date

N0


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