AIWU Application Form for Admission To register please access the form below.Additionally, please send all your supporting documentation to: aiwuniversity@gmail.com Open Form AIWU Registration APPLICANT INFORMATION Select your desired course: * RN to BSN BSN to MSN MSN to DNP MBA Todays Date * MM DD YYYY Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Course Admission Date MM DD YYYY Social Security Number DOB MM DD YYYY Course Desired * Are you a citizen of the United States or a Green Card holder? * Yes No Have you ever been admitted by AIWU branch before? * Yes No Have you ever been convicted of a felony? * Yes No EDUCATION College or University Name College or University Address Address 1 Address 2 City State/Province Zip/Postal Code Country From MM DD YYYY To MM DD YYYY Did you graduate? Yes No Degree Result High School Name High School Address Address 1 Address 2 City State/Province Zip/Postal Code Country From MM DD YYYY To MM DD YYYY Did you graduate? Yes No Diploma Result References Ref 1 Name First Name Last Name Relationship Company Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Ref 2 Name First Name Last Name Relationship Company Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Ref 3 Name First Name Last Name Relationship Company Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country EMPLOYMENT HISTORY Company 1 Company Job Title Responsibilities Phone (###) ### #### Supervisor Starting Salary: $ Ending Salary: $ From MM DD YYYY To MM DD YYYY Reason for leaving: May we contact your previous supervisor for a reference? Yes No Company 2 Company Job Title Responsibilities Phone (###) ### #### Supervisor Starting Salary: $ Ending Salary: $ From MM DD YYYY To MM DD YYYY Reason for leaving: May we contact your previous supervisor for a reference? Yes No MILITARY SERVICE Branch From MM DD YYYY To MM DD YYYY Rank at Discharge Type of Discharge If other than honorable, explain: DISCLAIMER AND SIGNATURE Comments and/or Additional information before signature: I certify that my answers are true and complete to the best of my knowledge. If this application leads to AIWU admission, I understand that false or misleading information or lack of disclosure in my application or interview may result in my application denial or dismissal. Signature: Date MM DD YYYY Thank you for your application for admission to AIWU, we will get back to you within 5 working days. For payments please contact us on: 302-985-2099
