School of Information Resources and Library Science

Continuing Education (Non-Degree Seeking Students)

APPLICATION FORM

Name: _________________________________________ Application Date: __________

Student ID:______________________________________ Date of Birth: ___________

Present Address:
_________________________________________________

_________________________________________________

Home Phone: _____________________________

Message Phone: _____________________________

Email Address (REQUIRED): ____________________________________________________________

I intend to apply or reapply to the SIRLS Master’s degree program:
YES NO

Semester to begin degree: Year: 20_____

___ Summer Session II/Fall (July) ___ Spring/Winter (January) ___ Summer I (June)

Primary Location: __________ On Campus __________ Virtual

Arizona Resident: __________ Yes _________ No Country of Citizenship: ____________

Level of attendance:

_________ Full time (at least 9 units)

_________ Part time (less than 9 units)

_________ Summer only

Area(s) of Interest (e.g. archives, info technology, public library, etc.):

_______________________________________________________________________________

_______________________________________________________________________________

How did you hear about the program?

_____ Conference exhibit _____ Friend _____ Co-worker

_____ Website, please specify ( SIRLS , ALA , Newsweek, etc____________________

_____ Other, please specify _____________________________________________