Fill-out the information necessary to receive information on your desired degree program. Please allow one week for your requested materials to arrive by mail. *Denotes required information.
		*Degree:
		*Major:
		*First Name:	Middle Initial:
		*Last Name:
		*Address:
		*City:
		*State/Province:
		*Country:	*Zip:
		Home Phone:	Work Phone:
		Fax:	E-Mail:
		Marital Status:	Single:       Married:       Single Parent:
		Sex:	Male:     Female:     Date of Birth:
		*Occupation:
			* How long have you been employed?    Years Select the highest education you've completed:   Select One None Less than grade 12 High School Graduate G.E.D. College-1 year College-2 years College-3 years College-4 years College-Bachelor Degree College-Masters Degree College-Doctorate
			* What degrees, certifications, professional licenses, if any, do you currently hold? List degree, major, graduation date and number of units earned. Where did you hear about Shepperton University?: Select One Yahoo USA Today B2B Army Times Publication Psychology Today Writer's Digest Northwest Air American Way Southwest Spirit American West Referral Friend Environmental Magazine Popular Science Internet Free Forum NCOA Journal Jet Observer - Soundings Bookmark Postcard WAUC Referral Re-Enrollment Ah-Ha Referred by a Friend
			Certification: I understand that this request for information will become part of my official application upon being accepted as a student at Shepperton University.     If you choose to print and fax this form, sign and date to authorize.