Social Security Number _____- ____ - _____ Male Female

Date of Birth ________/________/________

Name: Last ________________________________ First ____________________________ Middle _______________________

Other Surname: _______________________________________________
(If you educational records are under any other name please indicate in full.)

Home Address:

Street _____________________________________________________________ Phone (______)_________________________

City __________________________________________ State __________________________ Zip ________________________

Business Address:

Company Name_____________________________________________________

Street _____________________________________________________________ Phone (______)_________________________

City __________________________________________ State __________________________ Zip ________________________

When do you plan to begin your studies? Year 20 ________term: Fall Spring Summer

Beginning with undergraduate study, list all educational institutions which you have attended:

Beginning with your present position, list below the various jobs which you have had:

Position _________________________________	Employer _________________________________	Date _________________________________
_________________________________	_________________________________	_________________________________
_________________________________	_________________________________	_________________________________

Indicate membership in any professional organizations (note offices held).

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

List any professional designations, licenses or registrations held.

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Please indicate if you have knowledge in any of the following areas, either through academic courses or on-the-job learning:

Area Principles of Accounting	Yes ______________	No ______________
Principles of Economics	______________	______________
Money and Banking	______________	______________
Financial Management	______________	______________
Business Law	______________	______________
Business Ethnics	______________	______________
Computer Science: Financial Application	______________	______________

State briefly your reasons for applying to this program:

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Signature ________________________________________________________________________ Date _______________________

This completed application should be mailed or faxed to the following:

Continuing Education & Professional Studies
C.W. Post Campus of Long Island University
Brookville, New York 11548
Fax (516) 299-2066