Last Name First Name Middle Initial Former Name (Optional)

Street Address Apartment/Suite

City State Zip/Postal Code Country

County (required for MN/NJ/NY/OH residents)

( ) ( )

Home Telephone Business Telephone

( )

Mobile Telephone E-Mail Address

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Are You a U.S. Citizen or Permanent Resident? Yes No If No, Country of Citizenship

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Spouse’s Name (Optional) Person to Contact in Emergency Telephone

Regarding the next four fields, see Personally Identifiable Information disclosure on back page.

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Gender Male Female

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Ethnicity Caucasian African American Hispanic Asian/ American Indian/ Unknown(Non-Hispanic) Pacific Islander Alaska Native

Social Security Number

Date of Birth (MM/DD/YYYY)

If you previously applied to Keller, date of last admission test

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Are you currently working with a Keller admissions representative? Yes No

If yes, please provide his/her name

The mission of Keller Graduate School of Management is to provide high-quality,practitioner-oriented graduate management degree programs with an emphasis onexcellence in teaching and service to adult learners.This mission is backed solidly by 75 years of educational excellence and service, as well as our accreditation.DeVry University is accredited by The Higher Learning Commission of theNorth Central Association, www.ncahlc.org.The University’s Keller GraduateSchool of Management is included in this accreditation.

Application for Admission

Personal Information

Administrative OfficesDeVry UniversityKeller Graduate School of Management One Tower LaneOakbrook Terrace, IL 60181-4624630.574.1960888.KELLER.0www.keller.edu

For Office Use Only

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Date Entered

Entered by (Initials)

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List all colleges, universities and graduate schools you previously attended or currently attend.

g Name and Location of Institution

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Dates Attended (From-To) Attended as: Undergraduate Graduate Both

g Name and Location of Institution

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Dates Attended (From-To) Attended as: Undergraduate Graduate Both

g Name and Location of Institution

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Dates Attended (From-To) Attended as: Undergraduate Graduate Both

Highest Degree Earned Graduation Date

Name of institution from which you have or will have earned your bachelor’s degree

Describe your undergraduate program (and graduate program, if applicable); include grade point average, major, honors and awards.

GPA Out of Major

( )

Current Employer City State Telephone

Title Dates Employed (From-To) Supervisor’s Name

Summarize your current job duties and responsibilities.

Briefly describe other work experiences (if applicable).

In what activities, including family obligations, do you actively participate outside the context of your full-time employment?

You may be able to take advantage of a reduced tuition rate. If your employer partners with DeVry University through the Corporate Education Program, reduced tuition is available.In addition, special pricing is available for active-duty military personnel serving in any of the five branches of the U.S.Armed Forces (including National Guard and Reserves) and their spouses.

Education

Employmentand Activities

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Discuss why you have decided to pursue a graduate program at this time.

Describe your most significant career accomplishments and why you view them as such.

How do you envision your career five years from now?

Describe how you feel your graduate education will help you achieve your career goals.

Keller offers seven master’s degree programs and the opportunity to tailor your education with a variety of concentrations and graduate certificates.

Which Keller master’s degree program(s) do you plan to pursue?

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MBA MAFM MPM MHRMMaster of Master of Master of Project Master of HumanBusiness Accounting Management Resource Administration and Financial Management

Management

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MPA MISM MNCM UndecidedMaster of Public Master of Master of Administration Information Network and

Systems Communications □

Management Management Student-at-Large

In which of our six annual sessions do you plan to begin your education?

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July September November January March May

In which year do you plan to begin your program?

A number of financing options may be available to help qualifying students meet educational expenses. Keller admissions representatives can provide details on federal financial aid programs, as well as on payment options available through the School.In addition, many students take advantage of employer tuition reimbursement.

Does your employer offer tuition reimbursement? □ □

Yes No

Is your employer a DeVry Corporate Education □ □

Program participant? Yes No

Do you plan to apply for an educational loan? □ □

Yes No

Are you or your spouse in active duty in the U.S. military? □ □

Yes No

Are you currently incarcerated? □ □

Yes No

ProfessionalCareerObjectivesand Goals

KellerProgramOfferings

FinancingYour KellerEducation

Undecided on which program?

g MBA with concentration?g Specialized master’s degree?g Graduate certificate?

Take advantage of a complimentaryconsultation with one of Keller’sadmissions representatives.

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Applying to Keller Graduate School of Management requires no application fee.To complete the application process,simply follow these few steps:

g Complete, sign, and fax or mail this application directly to the location you plan to attend. Fax numbers and mailing addresses are available via www.keller.edu.Applications may also be submitted in person.

g Complete an interview with an admissions representative.

g Submit proof of graduation.Acceptable documents include “Issued to Student” transcripts and copies of diplomas.

g Submit official academic transcripts from the college or university where the baccalaureate or advanced degree was earned withinsix weeks from the start of the first session of enrollment.Transcripts marked “Issued to Student” are not accepted as official.

g Provide GMAT or GRE scores, or take our alternative admission test, which can be completed in approximately one hour at the time of the interview at no charge. GMAT and GRE test scores are valid up to five years from the date of test completion.No time limit applies to scores from our alternative admission test.

Complete admission requirements, as well as details on all School policies, are outlined in Keller’s academic catalog.

Applicants will be notified of their acceptance or rejection within one week of completing all application procedures.They willthen be instructed on any prerequisite skills coursework that may be required before they may enroll in most courses at the 500 level or above.Applicants seeking readmission should refer to the academic catalog.

Tuition Deposit/Cancellation PolicyUpon completion of the application process, a $100 tuition deposit is due.The deposit is credited toward the first session tuition or refunded if the applicant is not accepted. If enrollment is cancelled after this deposit is made, a full refund, less a $50 administra-tive fee ($25 in Oregon), is issued upon request. Should receipt of the tuition deposit and cancellation fall within three businessdays of acceptance (five business days in Ohio and Minnesota; six business days in Indiana), no administrative fee will be charged.Refunds are not issued after one year.

DeVry University has adopted privacy policies and practices designed to protect students’ personal information. Only informationrequired to efficiently conduct our business and meet state and federal reporting requirements is collected.The information collect-ed is only disclosed as permitted under the Family Educational Rights and Privacy Act of 1974, as amended (FERPA). DeVry’sFERPA policy is printed in the student handbook and is available for review in the Student Services Office.

DeVry University is required to collect the social security number (SSN), gender, ethnicity and date of birth for a variety of legally mandated activities, including income tax reporting and administration of federally supported financial aid programs.TheSSN is not used as the student’s primary identification; gender, ethnicity and date of birth are not used in determining admission.Students who do not provide the SSN at the point of application may experience a delay in financial aid processing.

I affirm that the above statements are true and correct to the best of my knowledge and belief. I understand that any false or misleading statements may constitute grounds for denial of admission or later expulsion. I also understand that program availabilityand degrees awarded vary by location. I have read and understand Keller’s Academic and Professional Conduct policy stated in theacademic catalog. I also grant the School permission to use my photograph in its catalog or School brochures. By signing below, Iauthorize Keller to contact me by telephone to discuss educational services provided by Keller Graduate School of Management.

Applicant’s Signature Date

Note: DeVry University operates as Keller Graduate School of Management and DeVry Institute of Technology in New York.

09-102111 06/07

AdmissionProcedures

Final Step

PersonallyIdentifiableInformation

The credibility you expect.The flexibility you need.

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