UHV International MBA Application

Program Name

Planned Entry Semester

Social Security Number or National ID:

- Full Legal Name -
Surname 
Suffix (Jr., Sr.) 
Given Name 

Middle Name 

- Mailing Address and Contact Information -
Street Address

City State/Province Postal Code 
Country Email 

Phone Number (Please include country code if applicable.) 

- Education -
Indicate the highest academic level you will have achieved before entering the University of Houston-Victoria.
High SchoolAssociate or Certificate Bachelors Masters Doctoral

Other
High School Name City 
State or Province Country 
Did you graduate? Yes No
List all colleges/universities you have attended, beginning with the most recent one.
School or InstitutionCityState/ProvinceCountry# Credits Earned

- Employment -
# Work Hours/Week 
(If not employed, enter "0".)		Title 

Employer 


- Residency -
Birthplace
City State/Province Country 
What is the country of your citizenship? 
If you are not a U.S. citizen, do you hold Permanent Residence status for the U.S.?Yes No
Do you hold a U.S. visa?Yes  NoIf yes, what type? 
Have you resided in Texas for the past 12 months?Yes  No   If no, where? 
Have you been employed in Texas for the past 12 months?Full Time  Part Time  No
List all jobs held in Texas, beginning with the most recent:
Name of CompanyCityFrom MM/YYTo MM/YY
The U.S. Department of Education requires us to ask for the following information under the provisions of Title VI of the Civil Rights Act. You are not required to answer these questions, and your answers will not be used for discriminatory purposes.
- Ethnicity -
White/Non-Hispanic
Asian/Pacific Islander		Black/African-American
Native American/Alaskan Native		Hispanic
- Gender -
Male  Female
- Date of Birth -
After submitting your application, you must print your confirmation page, sign and date it, and mail it to the address provided on the confirmation.