Non-degree Admission Application | Richmont Graduate University Dev

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When all of your application materials have been received, you will be notified in writing.

Once your file is complete, our review process will begin. If Richmont is unable to accept your application, we will notify you as soon as possible. Please call 888.924.6774, with any questions regarding your application and its status.

A Non-degree or ISW student who has not taken a course with Richmont for a period of one year or more must submit the “Non-Degree/Institute for Sexual Wholeness Registration Update” form. The Admissions Office will review this form and notify the student when they are cleared to register for classes with the Registrar’s Office. This form can be found on the Richmont website under http://richmont.edu/prospective-students/admissions-nondegree-isw/non-degree-admission-application/.

FED School Code G33554

Applicant Information

First Name (Legal)

Middle

Last

Social Security Number Enter as: 123-11-1234 or 123111234

Birth Date Enter in mm/dd/yyyy format

Gender FemaleMale

Program Information

Starting Time: FallSpringSummer

Starting Year

Schedule Full-TimePart-Time

Have you ever applied to Richmont before? NoYes

Date Enter in mm/dd/yyyy format

Degree Institute for Sexual Wholeness
Non-Degree

Graduate Certificates (optional) Addictions Counseling
Child and Adolescent Counseling
Christian Sex Therapy
Spirituality and Counseling
Trama Counseling

General Information (Optional)

Ethnicity Race and ethnicity unknown

Select one of the following: Hispanic/LatinoNot Hispanic/Latino

Select one of the following: American Indian/Alaskan Native
Asian, Asian American, or Pacific Islander
White (Non-Hispanic)
Black or African American
Mexican, Mexican America or Chicano
Puerto Rican
Other Hispanic or Latin American
No Response

Other

Marital Status SingleEngagedMarriedSeparatedDivorcedWidowed

If married, spouse's name

Is there any family situation that may affect your graduate study? NoYes

Please explain the situation *

Citizenship

U.S. CitizenU.S. Permanent ResidentInternational ApplicantNon-resident/Alien

State of Legal Residence

Registration Number

Country of Citizenship *

If currently in U.S., indicate Visa type

Permanent Mailing Address

Street Address

Address continued

City

State

Zip

Mailing Address (If different from above)

Street Address

Address continued

City

State

Zip

Telephone

( )

Daytime Telephone

( )

Educational Background

Was the school from which you received your degree(s) regionally accredited? NoYes

Agency Name Accreditation Organization

*Please have one official transcript from each of the post-secondary institutions you have attended sent to Richmont, even if credits were transferred to graduating university.

Undergraduate Education (list all)

School Name

City

State

Country

Dates of Attendance

Start Date Enter in mm/dd/yyyy format

End Date Enter in mm/dd/yyyy format

Major

Hours Earned

Grade Point Average

Degree/Date Earned or Expected

Add another institution

Graduate Education (list all)

School Name

City

State

Country

Dates of Attendance

Start Date Enter in mm/dd/yyyy format

End Date Enter in mm/dd/yyyy format

Major

Hours Earned

Grade Point Average

Degree/Date Earned or Expected

Add another institution

Optional Questions

Do you have a physical disability for which accommodations need to be made? NoYes

Please provide details

Do you have a substance abuse problem that will impair your abilities as a graduate student or mental health practitioner? NoYes

Please explain the nature and extent of the problem and to what degree your participation in graduate school or professional practice may be affected. If recovering, please provide dates of continuous recovery.

Have you ever been convicted of a crime (other than traffic), or are you currently under indictment for an alleged crime? NoYes

Please explain

Are you fluent in both oral and written English? NoYes

Are you a veteran? NoYes

Military affiliation

At Richmont you will be expected to use computer technology to produce documents, send e-mail and navigate the Internet. Please rate your computer literacy and technological competence. Very CompetentCompetentModeratePoor

Please explain

Please indicate how you heard about Richmont: Former or current student
Radio advertisement
Magazine advertisement
Internet
Faculty member or advisor
Recruitment representative
Pastor or other church leader
Other

Name

Station

Magazine

Web Site

Name/School

Name/Location

Name/Church

Specify

I hereby certify that the information in this application is true and complete without evasion or misrepresentation. I understand that if it is found to be otherwise, it is sufficient cause for rejection or dismissal. *

I also certify that I have reviewed the Statement of Faith in the Richmont catalog and understand that Richmont affirms these theological beliefs. *

Name * Please enter your full legal name

Date *

After you select the 'Submit' button below, you will be directed to our online payment system. This application must be accompanied by a non-refundable $50 application fee. A late fee of $25 will be required in addition to the regular application fee if applying after the final deadline or if the application fee has not been received before then.

When all of your application materials have been received, you will be notified in writing.

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