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Application!for!Executive!Certificate!in!Public!Policy!
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DU!ID!______________________________________!!!Year!________________!!!!!☐!Spring!!!!!☐!Fall!!!!☐ Winter!
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Name!____________________________________________________________________________________________________________!
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Mailing!Address
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Social!Security!Number!_______________________!Birthday!(mm/dd/yy)!_____________!!
DU!Employee!!☐ Yes!!!☐ No!
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Have!you!previously!applied!to!the!University!of!Denver?!!!☐!Yes!!!☐!No!
Have!you!previously!registered!at!the!University!of!Denver?!!!!☐!Yes!!!!☐!No!
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Eligibility!for!the!Executive!Certificate!Program!is!dependent!on!receipt!of!proof!of!bachelor’s!degree.!
Please!indicate!the!name!of!the!institution!at!which!you!earned!your!baccalaureate!degree.!An!
unofficial!transcript!or!proof!of!degree!is!required.!!
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Name!of!institution!____________________________________________________!Date!of!degree!_______________________!
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English(Proficiency!–!NonPnative!speakers!of!English!are!required!to!demonstrate!English!
proficiency.!Students!holding!baccalaureate!degrees!but!who!do!not!intend!to!pursue!a!degree!
program!may!be!admitted!under!special!status.!Proof!of!bachelor’s!degree!is!required!under!special!
status.!International!applicants!must!demonstrate!proof!of!English!language!proficiency!and!submit!
the!International!Special!Status!Supplement!form.!For!information!related!to!English!proficiency!
requirements,!please!visit!the!International!Applicant!website!
(http://www.du.edu/learn/graduates/internationalapplicants.html).!
What!is!your!native!language?!____________________________________________________________________________!
Citizenship!–!International!and!U.S.!Permanent!Resident!applicants!are!required!to!submit!the!
International!Special!Status!Supplemental!Form.!The!University!of!Denver!does!not!issue!
immigration!documents!for!special!status!students.!☐!U.S.!Citizen!☐!U.S.!Permanent!Resident!(attach!
the!International!Special!Status!Supplemental!Form!
http://www.du.edu/media/documents/graduates/SSIntl.pdf)!
☐!International!Applicant!(attach!the!International!Special!Status!Supplemental!Form!
http://www.du.edu/media/documents/graduates/SSIntl.pdf)!
Demographic(Information!–!The!University!of!Denver!values!the!diversity!of!its!student!body.!We!
collect!this!data!as!one!measure!of!our!diversity!progress!and!to!comply!with!federal!law.!We!request!
your!voluntary!cooperation!in!identifying!yourself!as!closely!as!you!can!with!the!racial!and!ethnic!
reporting!categories!below.!If!the!offered!categories!do!not!describe!you!accurately,!please!select!the!
closest!option(s)!listed.!The!information!you!provide!will!not!be!used!in!any!discriminatory!manner.!
Thank!you!for!your!assistance.!
Gender!☐ Male!☐ Female!!
Do!you!consider!yourself!to!be!Hispanic!or!Latino?!☐ Yes!☐ No!!
In!addition,!please!select!one!or!more!of!the!following!racial!categories!to!describe!you:!☐ American!
Indian!or!Alaska!Native!☐ Asian!☐ Black!or!African!American!☐ Native!Hawaiian!or!Pacific!Islander!
☐ White!
Are!you!an!active!or!reserve!member!of!the!United!States!armed!forces!or!National!Guard?!!!!!!!!!!!!!!!!!!!
☐ Yes!!☐ No!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Are!you!a!veteran!of!the!United!States!Armed!Forces?!☐ Yes!!!☐ No!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Will!you!be!using!VA!Benefits?!☐ Yes!!!☐ No!
Additional(Items(–(Please!attach!a!professional!resume!and!two!letters!of!recommendation!along!
with!a!transcript!as!proof!of!a!bachelor’s!degree!from!an!accredited!university.!
Please(Note(<(Acceptance!into!this!program!is!dependent!upon!your!previous!education!and!work!
experience!and!does!not!imply!that!you!have!been!accepted!into!a!degree!program!at!the!Daniels!
College!of!Business.!If!in!the!future,!you!seek!acceptance!into!a!degree!program,!you!will!need!to!
complete!the!required!application!materials!at!that!time.(
Applicant(Signature(
I!certify!that!I!am!in!good!standing!academically!and!financially!in!all!colleges!and!universities!
attended,!and!that!all!information!provided!above!is!true!and!complete.!I!understand!that!this!
application!form!and!all!other!records!gathered!for!my!admission!files!are!confidential!and!will!not!
be!disclosed!to!me!or!any!other!person,!except!at!the!sole!discretion!of!the!Daniels!College!of!
Business.!By!signing!this!form,!I!agree!that!I!understand!and!will!comply!with!the!university!policies!
related!to!being!a!student!at!the!University!of!Denver.!(
Signature:!_________________________________________________________!Date!___________________!
NOTE:!An!overall!GPA!of!3.0!is!required!for!this!Certificate.!Program!requirements!are!subject!to!
change!without!notice.!
The!University!of!Denver!is!an!Equal!Opportunity!Institution.!It!is!the!policy!of!the!University!not!to!discriminate!in!the!
admission!of!students,!in!the!provision!of!services,!or!in!employment!on!the!basis!of!a!person’s!race,!color,!national!origin,!age,!
religion,!disability,!sex,!sexual!orientation,!gender!identity,!gender!expression,!genetic!information,!marital!status,!or!veteran!
status.!The!University!complies!with!all!applicable!federal,!state,!and!local!laws,!regulations!and!Executive!Orders.!Inquiries!
concerning!allegations!of!discrimination!based!on!any!of!the!above!factors!may!be!referred!to!the!University!of!Denver,!Office!
of!Equal!Opportunity!and!ADA!Compliance,!Mary!Reed!Bldg.,!Room!422,!2199!S.!University!Boulevard,!Denver,!CO!80208.!
Phone!(303)!871P7436.!
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