Certificate Enrollment Application

Thank you for your interest in Southwest University. We look forward to serving you.

  Please complete the following form and click submit below. NOTE: Fields marked with an asterisk (*) are required.
First Name:Last Name: 
* * 
Street Address:  
City:State/Province:Zip Code:
* * *
Birth YEAR (YYYY): 
Please complete at least one of the phone numbers below as well as your email address:
Home Phone:Mobile Phone:Work Phone:
Email Address:  
Best Method to Reach You:Best Time to Reach You: 
Employer Information
Present Employer: Position:
City:State/Province:Zip Code:
Program Information
I am Applying for Admission to the Following Program:
Undergraduate Programs 

Graduate Programs 

When do you expect to start the program? 
Highest level of education you have completed: 
Formal Education  (Upon acceptance, Official College/University transcripts will be required):
Name of High School:Year Graduated:City:State:
* * * *
If not a high school graduate, you must have earned a GED. If so, enter date received:
College/University Name:Attendance:Degree (or # Credits)Date Graduated:
* * * * *
Tuition assistance: 
Other information, questions, or comments:  
I have read/downloaded the school catalog as posted on the Web site (available here) that explains the admissions criteria, nature of the education offered, and both mine and the university's rights and responsibilities. I understand the Distance Learning concepts utilized by the University. I further understand that a degree cannot be confirmed until all the degree requirements have been met and all financial obligations satisfied.
  do do not wish to have my prior and/or experiential learning evaluated for academic credit to be used to fulfill degree requirements. Credit given for prior and/or experiential learning will be entered into my record and onto a transcript upon graduation.
I understand that admission to any degree program is based on information given in my Application for Enrollment and supporting documents. I hereby give my consent to Southwest University to verify any information furnished by me as deemed by University to be relevant to my application.
Please fax a copy of any transcripts(s) you may have. Our fax number is 504.468.3213.
Processing Fees
Fees to pay now via debit/credit card:
Application Fee
Registration/Enrollment Fee
$200 (Non-Refundable)
Card Processing Fee
$6 (amounts under $100), $15 ($100 and up)
Card Type: Visa     Mastercard     Discover
Card No.:
Name on Card:
Exp. Date [MM/YY]:
If you would rather submit this information via fax, you can print this form and fax it to (504) 468-3213.