Application for Admission: MBA Charleston and Parkland Face-to-Face

Please fill in all information completely and accurately. The application form must be completed within one computer session since it cannot be saved prior to submission. You may wish to print a copy of the completed form prior to submission. For additional information about the admission requirements and required application materials, visit the MBA web site at www.eiu.edu/mba or contact the MBA office at mba@eiu.edu.

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First Name *
Middle Name
Last Name *
All Previous Names
Birth Date Birth Date * / MM / DD YYYY
Permanent Address Permanent Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Local Address (if different from Permanent Address) Local Address (if different from Permanent Address)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Home Phone Home Phone * - ### - ### ####
Work Phone Work Phone - ### - ### ####
Local/Cell/Other Phone Local/Cell/Other Phone - ### - ### ####
Illinois Resident? *

Illinois Resident? No Yes If yes, how long (years, months)? If yes, how long (years, months)?
Citizenship *

Citizenship U.S. Non U.S. If non U.S., Specify Country, Alien Registration Number, and Type of Visa

Application for Admission: MBA Charleston and Parkland Face-to-Face

Application for Admission: MBA Charleston and Parkland Face-to-Face

Page 1 of 5 - About You