Humanities Master of Arts Degree--External Program
Online Application

 

NOTE: Submitting this application is only part of the HUX program application process. Be sure to follow the instructions on the Admission Process page.

This form is for submitting an online application. If you wish to print out and mail or fax your application, go to the printed version.

Collection of information requested on this form and its maintenance by the Admissions Officer is authorized by university policy. It will be used to identify your records, previous education, educational goals, and special services you may need if enrolled, and may be accessed by you. Please type or print your answers, sign, date, and return the Application, Fee, Intellectual Autobiography, and transcripts to the Humanities External Degree office. Incomplete answers will delay your admission.

You are welcome to expand on any area (if you fill a text entry box, you may just scroll down to continue entering text).

* Denotes a required field.

*1. Term for which you are applying:
*2. Social Security number:
*3. Legal Name as you wish it to appear on your records (last, first, middle):
*4. Other Name(s) that may appear on your records:
*5a. Address:
*City:
*State:
*Country:
*Zip Code:
*5b. Permanent address (if different from above):
*6. Email address:
*7a. Home Phone:
International cd: ( )
7b. Business Phone:
International cd: ( )
*Best time to call at home (California local time):
7c. FAX Phone:
International cd: ( )
Best time to call at work:

Do not call my work
*8a. Birthdate (single digit number should be preceded by a zero: mm/dd/yy)
*8b. Place of birth:
*9. Sex (mark one)

Male Female
*10. Have you ever been accepted into this program?

Yes No Date:
*11. If so, did you enroll?

Yes No
*12. Are you under academic or disciplinary suspension, disqualification, expulsion or similar action at any institution (including the one to which you are applying?) If yes, attach explanation and indicate institution.

Yes No
*13. Ethnic Identity: Select the most appropriate box. Your response will not affect your admission to the university. The information is collected only for statistical purposes.
*14. Do you need special services to accommodate a physical, perceptual or learning disability or more information about these services?

Yes No

*15. List in chronological order names and locations of all institutions enrolled in after high school. Do not list CSUDH attendance unless applying for readmission

Institution

Time of Enrollment
From (mm/yy)/To (mm/yy):

Units Completed
Semester/Quarter
Degree Earned
Date (to be) Received (mm/yy)

*16. Employment: List all applicable employment. Indicate present employer, if now employed.

Employer
Nature of Work
Inclusive Dates

Sent to AO:

Reminder: Two (2) sealed Official Transcripts are needed from each school attended. Compilation-style transcripts are not sufficient for admission review.

*17. CERTIFICATION -TO BE READ AND SIGNED BY ALL STUDENTS TO CERTIFY THE ACCURACY OF THE INFORMATION PROVIDED: I certify that the information submitted in this application is true, complete and accurate. I understand that any misrepresentation will be cause for denial of admission. I authorize release of my information submitted by me in connection with my application for admission and determination of residence to my person, firm, corporation, association or government, whether federal, state, local or foreign, but only as necessary to verify or explain the information, to obtain pertinent records, or in connection with perjury proceedings.

Choose the I Certify button below as your signature to this application and declaration.

I Certify the above to be true.

I do not certify the above.


Date:

Please direct questions to the address below:

Humanities External Degree Program
California State University, Dominguez Hills
1000 East Victoria Street - SAC2-2126
Carson, CA 90747 USA

(310) 243-3743
Email: huxonline@csudh.edu