Graceland University

Science Safety for Educators

To inquire about enrolling immediately, call 1-800-833-0524, ext. 4516 or email distancelearning@graceland.edu.


PERSONAL INFORMATION
Please enter your full legal name:
Full First Name*
Middle
Last*

Preferred Greeting Name (Liz for Elizabeth, Bill for William, etc.)
Previous Last Name (Maiden name for example)
Other names

Email* (For example me@aol.com is a valid format.)

Confirm Email*

Home Address*



City*
State/Province*
Zip/Postal Code*
Country*
Primary Phone* Example: 111-222-3333
Secondary Phone Example: 111-222-3333
Citizenship*
Resident Alien* Yes No
Birth Country*

Birth Date: Month* Day* Year* Enter all 4 digits of the year
Gender* Male Female
Social Security Number (U.S.) or Canadian SIN Example: 111-22-3333


Have you previously applied for admission to Graceland? Yes No Date
Do you have a bachelors degree? Yes No
If so, from what institution did you receive your degree?

Do you have a masters degree? Yes No
If so, from what institution did you receive your degree?

I would like to receive additional information about Graceland's educational programs.

How did you hear about this program?

Click here to view the eCollege Technical Requirements and Click here for the payment form.


CONTRACT
I understand that withholding information requested on this application or giving false information will make me ineligible for admission to Graceland University or subject to dismissal. I also understand that the submission of fraudulent academic records by a student for undergraduate admission, transfer of credit, or any other purpose shall be cause for dismissal from the University. I certify that the information given in this application is complete and accurate, and if admitted, I agree to comply with the regulations of the University.

PLEASE NOTE: Other admission requirements, as listed in the university catalog, must be met before your application is considered complete.

APPLICANT'S NAME*


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POLICY ON NONDISCRIMINATION

Graceland University does not discriminate against any student or prospective student on the basis of race, color, religion, age, sex, national origin, disability, or sexual orientation. We are a caring community dedicated to the physical, intellectual and spiritual well-being of each individual. Gracelanders join together to create an atmosphere of openness, mutual respect and diversity.