IMUA

Name

First NameLast Name
Date of Birth:
MM/DD/YYYY
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
Phone number
000-000-0000
Alternative Phone
000-000-0000
Social Security Number
Gender
Ethnicity
Classes
Start Date
MM/DD/YYYY
In order to apply, students must submit a Student Application Form with a $75.00 non-refundable registration fee. The balance of tuition is due 3 days after acceptance letter unless prior arrangements have been made.
I certify that the above information is correct to the best of my knowledge. I understand that withholding information or giving false information may make me ineligible for admission to IMUA.
Signature

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year

Application Fee$75.00

Total $0.00