Program Application

Thank you for your interest in applying to our institutional programs using our eHBCU website. This form collects essential personal, academic,
and demographic information to support your application process. Please complete all required sections accurately.

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Section 1: Personal Information

First Name:*

Middle Initial:

Last Name:*

Gender:*

FemaleMaleNonbinaryOther

Preferred First Name:

Pronoun:*

She/HerHe/HimThey/ThemOther

Date of Birth:*

MonthMonth123456789101112

DayDay12345678910111213141516171819202122232425262728293031

YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Race Ethnicity

Black/African AmericanHispanic/LatinoWhiteAmerican Indian/AlaskanNative Hawaiian/Pacific IslanderOther

Section 2: Enrollment Details

Institution Selected:*

Select an InstitutionAlabama State University – ASUDelaware State University – DSUMedCertsPensole Lewis College of Business and Design – PLCSouthern University and A&M College – SUBRSouthern University at New Orleans – SUNOSouthern University at Shreveport – SUSLA

Program of Study Selected:*

Select a ProgramAssociate of Applied Science in Criminal Justice AdministrationAssociate of Arts in Liberal StudiesAssociate of Arts Louisiana Transfer in Biological SciencesAssociate of Arts Louisiana Transfer in Criminal JusticeAssociate of Arts Louisiana Transfer in General BusinessAssociate of Arts Louisiana Transfer in HumanitiesAssociate of Arts Louisiana Transfer in Mass CommunicationAssociate of Arts Louisiana Transfer in Physical SciencesAssociate of Arts Louisiana Transfer in Social SciencesAssociate of General Studies in BiologyAssociate of General Studies in Business AdministrationAssociate of General Studies in ChemistryAssociate of General Studies in General EducationAssociate of General Studies in HumanitiesAssociate of General Studies in Physical SciencesAssociate of General Studies in Pre-EngineeringAssociate of General Studies in Pre-PhysicsAssociate of General Studies in PsychologyAssociate of General Studies in Science/Pre-HealthAssociate of General Studies in SociologyAssociate of Science in Biological SciencesAssociate of Science in Business ManagementAssociate of Science in PsychologyAssociate of Science in Public HealthAssociate of Science in Social WorkAssociate of Science Louisiana Transfer in Biological ScienceAssociate of Science Louisiana Transfer in General BusinessAssociate of Science Louisiana Transfer in Physical SciencesBachelor of Arts in Liberal StudiesBachelor of Arts in PsychologyBachelor of Arts in Public AdministrationBachelor of Science in AccountingBachelor of Science in Criminal Justice AcceleratedBachelor of Science in Health Information Management Systems (HIMS)Bachelor of Science in Interdisciplinary StudiesBachelor of Science in ManagementBachelor of Science in Nursing for Registered Nurses with Associate DegreesBachelor of Science in PsychologyBachelor of Science in Psychology AcceleratedBachelor of Science in Public HealthBachelor of Science in Social WorkBachelor of Science, Accelerated Criminal JusticeCertificate – Adobe IllustratorCertificate – Adobe InDesignCertificate – Adobe SubstanceCertificate – Alcohol & Drug Counseling ProgramCertificate – Applied Science in CybersecurityCertificate – Applied Science in Digital ForensicsCertificate – Applied Science in Graphic and Web DesignCertificate – Applied Science in Graphic DesignCertificate – Applied Science in Web DevelopmentCertificate – Autodesk 3D Design-Fushion 360Certificate – Blender 3D DesignCertificate – Cannabis Agriculture & HorticultureCertificate – Cannabis Compliance & Risk ManagementCertificate – Cannabis Healthcare & MedicineCertificate – Cannabis Product Development & DesignCertificate – CLO 3D Apparel DesignCertificate – Coding for Health Information ManagementCertificate – Community Health WorkerCertificate – Data Mining and Decision-MakingCertificate – Drawing and Sequential Art-Visual StorytellingCertificate – Epic Game DesignCertificate – Graphic DesignCertificate – Gravity Sketch 3D Design Footwear DesignCertificate – Health Care Technology to Advance the Adoption of Information SystemsCertificate – Health Management for Advancement in LeadershipCertificate – Operations ManagementCertificate – Programming Skills: PythonCertificate – Real Estate and FinanceCertificate – Sales ManagementCertificate – Solidworks 3D DesignCertificate – Teacher of English Language LearnerCertificate – Teaching English to Speakers of Other LanguagesCertificate – Technical Studies in Computer Networking TechnologyCertificate – Technical Studies in EngineeringCertificate – The Business of CannabisCertificate – Web DesignCertification – Front-End Web Design & DevelopmentCertification – Administrative Assistant with Bookkeeping and Quick BooksCertification – Adobe Design SuiteCertification – Allied Healthcare ProfessionalCertification – Associate Professional in Human ResourcesCertification – AWS Solutions Architect AssociateCertification – AWS SysOps Administrator AssociateCertification – Behavior Technician and the Medical OfficeCertification – Behavior Technician SpecialistCertification – Business Management ProfessionalCertification – Cardio-Phlebotomy TechnicianCertification – Cisco Certified Network AssociateCertification – Clinical Medical Assistant & Scribe ProfessionalCertification – Clinical Medical Professional (Medical Assistant + Phlebotomy Tech + EKG Tech)Certification – Clinical Medical Specialist (Medical Assistant + Phlebotomy Tech)Certification – Cloud Computing (Cloud+)Certification – Cloud Database Administrator for Microsoft AzureCertification – Cloud Technology ProfessionalCertification – Computer Security Technician (COMPTIA Security+ and Network+)Certification – Computer Support Specialist (COMPTIA A+ and Network+)Certification – Cybersecurity Analyst (CySA+)Certification – Dental AssistantCertification – EKG TechnicianCertification – Electronic Health Records & Reimbursement SpecialistCertification – Electronic Health Records SpecialistCertification – Ethical Hacker (PenTest+)Certification – Fundamentals of ITCertification – Geriatric Medical AssistantCertification – Health Unit CoordinatorCertification – Healthcare Administration ProfessionalCertification – Healthcare IT TechnicianCertification – Information Systems Security ProfessionalCertification – IT Helpdesk AdministratorCertification – IT Network TechnicianCertification – IT Security and Network TechnicianCertification – IT Security SpecialistCertification – IT Support ProfessionalCertification – Linux AdministratorCertification – Medical Administrative AssistantCertification – Medical AssistantCertification – Medical Billing and CodingCertification – Medical Billing and Coding with Medical Administrative AssistantCertification – Medical Billing SpecialistCertification – Medical Coding & Billing ProfessionalCertification – Medical Front Office Administration SpecialistCertification – Medical Front Office and Electronic Health RecordsCertification – Medical Front Office Assistant and  Administration SpecialistCertification – Medical Laboratory AssistantCertification – Medical Scribe & Administrative ProfessionalCertification – Medical Scribe ProfessionalCertification – Medication Care CoordinatorCertification – Mental Health and Professional CaregiverCertification – Mental Health Support ProfessionalCertification – Mental Health Support SpecialistCertification – Microsoft Office SpecialistCertification – NASM Personal Trainer & Nutrition CoachCertification – Paralegal ProfessionalCertification – Patient Care TechnicianCertification – PC TechnicianCertification – Pharmacy Technician Professional (ASHP/ACPE)Certification – Pharmacy Technician SpecialistCertification – Phlebotomy TechnicianCertification – Physical Therapy Aide and Administration SpecialistCertification – Physician’s Office Assistant with Electronic Health RecordsCertification – Professional Bookkeeping w/QuickBooksCertification – Professional CaregiverCertification – Professional CoderCertification – Project Management EssentialsCertification – Sterile Processing TechnicianCertification – Surgical TechnologistCertification – Surgical/Sterile Processing TechnicianDoctor of Education (Ed.D.) in Educational LeadershipDoctor of Philosophy in Educational Leadership, Policy, and LawDoctor of Social Work (DSW)Executive Masters in Criminal JusticeExecutive Masters in Public AdministrationFoot Locker THREADEDFuture Sole ProgramGraduate Certificate – Spanish for Social WorkGraduate Certificate – Supply Chain Management – AcceleratedGraduate Certificate – Supply Chain Management – Non-AcceleratedMaster in Public HealthMaster of Arts in Criminal JusticeMaster of Arts in Museum StudiesMaster of Arts in Teaching English to Speaker of Other Languages (TESOL)Master of Business AdministrationMaster of Education (MEd) in Educational Leadership in Adult and Higher EducationMaster of Education in Clinical Mental Health CounselingMaster of Education in Educational LeadershipMaster of Public AdministrationMaster of Rehabilitation CounselingMaster of Science in Applied TechnologyMaster of Science in Leadership StudiesMaster of Science in PsychologyMaster of Science in Sport AdministrationMaster of Social WorkMaster of Social WorkMasters of Business AdministrationMasters of Science in Nursing (MSN)​Certificate – Adobe Photoshop

How did you hear about us?*

eHBCU

Student Type:*

First Time FreshmanTransferReturningNon-Degree/VisitingGraduate/Doctoral

Start Month*

JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Start Year*

20262027202820292030

Section 3: Contact Information

Mobile Number:*

Email*

Preferred Contact:*

EmailPhone CallText

Section 4: Academic Background

Highest Education Completed:*

GEDHigh School DiplomaSome college but did not graduateAssociate DegreeBachelor's DegreeGraduate DegreeDoctoral Degree

High School Attended or Equivalent:*

Last College or University Attended:*

Last Institution's Cumulative GPA:*

9.999

Number of Transfer Credits*

Military Affiliation:*

Active DutyVeteranSpouse/DependentNone

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I authorize the release and sharing of my information with eHBCU and its consortium partners for the purpose of evaluating my admission eligibility, financial aid, and related educational services.

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If admitted, I agree to abide by the academic and student conduct policies of the institution in which I enroll.

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I understand that my application may be reviewed by more than one institution, and that each school may follow its own admissions policies and timelines.

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I understand that withholding information or providing false information may result in the denial of admission or dismissal from any institution within the eHBCU College Consortium.

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By signing below, I certify that all information provided in this application is accurate and complete to the best of my knowledge.

Signature*

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