Indiana University Kokomo
Application for Master of Public Management
SPEA, 2300 S. Washington Street, PO Box 9003, Kokomo, IN 46904-9003
(765)455-9330
_________________________________________________________________ _________________________
Last name First Middle Former Name
_________________________________________________________________ _________________________
Street Address Social Security Number
_________________________________________________________________ Male _____ Female _____
City State Zip Code
________________ (____) _______________ (____) ________________ Birthdate
County Home Phone Number Work Phone Number Month __ Day ___ Year ______
Term for which you are applying (please fill in year): List colleges/universities, dates attended and degree
___ Aug _____ (Fall) ___ May, ______ (1st Summer) received. Please include any IU Campus.
___ Jan ______(Spring) ___ June, ______ (2nd Summer) 1. ____________________________________________________
2. ____________________________________________________
Application deadlines are approximately three weeks prior to the 3. ____________________________________________________
start of the term. Consult Schedule of Classes or Office of
Admissions for deadlines.
Bachelor degree holding students planning on working
Residency (please answer both questions): towards the Post-Bachelor’s Certificate in Public Management
What is your state of legal residence? ____________________ are required to submit the following for admission:
How long in the immediate past have you lived in Indiana?
_______________________ ___ Completed Application for Master of Public Management
What is your citizenship status? (please check one)
___ U – U.S. Citizen ___ $40 application fee for Fall 2007 and later
___ F – Student Visa, Non-U.S. citizen
___ P – Permanent Resident (holder of Green Card) ___ Official college transcript(s)
___ O – Non U.S. Citizen ________________________ Students must have a cumulative grade point average
Country of citizenship of 3.0 or better. Students dismissed the last semester at
their previous college are required to submit a Petition
Ethnic Information (optional * -- please check one) for Admission. Please contact the Office of
___ A – Asian or Pacific Islander Admissions for specific information.
___ B – Black or African-American
___ C – Hispanic or Latino ___ Three reference letters
___ I – American Indian or Alaskan Native
___ W – White
___ X – Multiracial I certify that the information submitted in this application is
correct and accurate to the best of my knowledge. I understand
Have you been convicted of a felony or have you that the completion of this application does not constitute formal
engaged in behavior that resulted in injury to a admission and that I am responsible for initiating regular
person(s) or personal property1? application procedures for continued enrollment at Indiana
___ Yes ___ No University.
___________________________________________________
Applicant’s Signature
___________________________________________________
Date
* Ethnic information is gathered in compliance with Title VI of the Civil Rights Act of 1964 and Title IX of the Education Amendment of 1972, and is requested in reports required by the U.S. Department of Education. However, applicants are not required to answer questions about ethnic origin and refusal to answer will not affect admission. The policy of Indiana University regarding admission to programs prohibits discrimination on the basis of ethnic origin, race, sex, religion, or handicap. Any information given by the applicant will be kept confidential.
1 Criminal Activity Disclosure: Indiana University is committed to maintaining a safe environment for all members of the university community. As a part of this commitment, Indiana University requires all applicants who have been convicted of a felony or who have engaged in behavior that results in injury to person(s) or personal property to disclose this information as a mandatory step in the application process. A previous conviction or previous conduct does not automatically bar admission to Indiana University, but it does require review. Complete information must be sent to the IU Kokomo Office of Admissions at PO Box 9003, 2300 N. Washington Street, Kokomo, IN 46904-9003.