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  • Main Phone *
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  • Work Phone
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  • Mobile Phone
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  • Marital Status
  • Gender
  • Emergency Contact Phone Number 1
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  • Emergency Contact Phone Number 2
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  • Degree & Certificate Programs of Interest *
  • Time of Day
  • / / Pick a date.
  • Do you have a high school diploma or GED?
  • Citizenship
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  • Veteran
  • Employment Data

  • Previous Education or Training

  • Previous Education or Training - Part 2

  • Previous Education or Training - Part 3

  • Can you provide a health certificate stating that you are free of communicable disease?
  • All information provided is true and complete to the best of my knowledge. I understand that admission to the University of Antelope Valley is contingent upon submission of one of the following: official high school transcript, official G.E.D. test scores and satisfaction of any additional admission criteria. *