Hubbard College of Administration

1221 Rogers Street - Suite A, Clearwater, Florida 33756 Application for Admission to Continuing Education Certificate Programs or Courses
(Last Name) (First Name) (Middle Imtlal)

Local Address
Street City State Zip

Personal Information
Home Phone # Date of Birth Married _ _ Single__ Number ofChildren__ U.S. Citizen Visa Yes_ _ No Work Phone # Social Security # Divorced.__ Separated__ Widowed U.S.A. Veteran Yes_ _ No_ _ Permanent Resident Yes_ _ No_ _ Sex: Female_ _ Male_ _ Car_ _

Yes_ _ No__

Transportation
Pub Ii c_ _ Education High School Diploma Name ofSchool ColiegelUniversity Degree Yes_ _ No_ _ _
_ _2_ _3_ _4_ _ _

Walk_ _

GraduateIProfessional 1_ _2_ _3_ _4_ _ Degree

Special Skills
If you did not graduate from high school. do you have a QED? Yes_ _ No_ _ Have you ever used financial aid for educational purposes? Yes No_ _

Employment
Employer Length of Service Work Perfonned Address Hours

What do you hope to achieve in your studies of management and/or administration?

Do you have any practical experience in management or administration? If yes, describe:

What other schools have you investigated?

Have you ever applied for or received financial assistance? Explain:

Who do you look to for support in making this decision? _ _Employer _ _Parents _ _Spouse _ _Other

What obstacles, if any, could stand in the way of your attending Hubbard College of Administration International if you should be accepted? _ _Transportation _ _Vacation Interruption _ _Other (Please Explain) _ _Available Hours _ _Prior Commitment _ _Child care _ _Parent/Spouse Support

What are your goals that Hubbard College of Administration can help you achieve?

Notes:

All applicants must sign here I certifY that the information contained on this form is accurate and true. I understand that all materials pertaining to my application become the property ofHubbard College of Administration. I agree to abide by the rules and regulations of Hubbard College of Administration and to meet all financial obligations.

Signature
Reminder: Be sure to photo copy this fonn before mailing. Please send this form to Hubbard College of

Date

Administration.
Note: Changes are effected from time to time in the general regulations and in the academic requirements. There are. ofcourse, established procedures for making such changes which protect the individual student's interests and the integrity of the school. A curriculum or graduation requirement, when altered, is not made retroactive unless the alteration is to the student's advantage and can be accomplished within the span of time normally required for graduation.

Hubbard College of Administration admits students of any race, color, creed. sex. handicap, national and ethnic origin to all rights. privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color. creed, sex, handicap, national, or ethnic origin in administration of its educational policies, admission policies or other school administrative programs.

 ..

HUBBARD COLLEGE OF ADMINISTRATION OF FLORIDA

1221 Rogers Street, Suite A, Clearwater FI 33756

Enrollment on Self-Determination
No applicant will be accepted by Hubbard College of Administration who is not there on his or her own desire but who has been ordered to do a program or course by his company or organization or who has been ordered to complete a course of study by a manager, judge, relative or anyone other than the applicant.

Student Attest
I have read and understand the above policy. I attest that I have not been ordered to do a program or course by any company or organization and that I have not been ordered to complete a course of study by a manager, judge, relative or anyone else other than myself. It is my own personal desire to undergo a program of study at Hubbard College of Administration.

Student Signature

Date

Printed Name

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