Continuing Education Program Application

Once we receive your application, a member of our team will reach out to guide you through the next steps of the admission process.

If you have any questions in the meantime, please contact the Office of Admission at 419-448-2330 or admission@heidelberg.edu.

Personal Information

First Name (Given Name)

Middle Name

Last Name

Suffix

Preferred First Name

Former Last Name (Additional name that may appear on your records (i.e. maiden name, former married name))

Sex
Your response will not affect your admission decision.

Date of Birth

Country of Citizenship
Your response will not affect your admission decision.

Contact Information

Preferred Telephone

Cell

Home

When entering your phone number, please begin your number with "+country code". For example, students from Germany would use "+49" followed by their phone number.

Cell Phone Number

Home Phone Number

Email Address

Address

Mailing Address

Country

Street

City

Region

Postal Code

Is your permanent home address the same as your mailing address?

Yes

No

Permanent Home Address

Country

Street

City

Region

Postal Code

Enrollment Information

Select your intended start term:

List the course(s) in which you plan to enroll:

Have you previously attended Heidelberg?

Yes

No

Education Information

When were you last enrolled at Heidelberg?

Bachelor's Degree Earned?

Yes

No

College/University Name

College University Code

College/University Address

Country

City

Region

Postal Code

Dates Attended (mm/yy-mm/yy)

Employer Information

Name of Employer

Employer Address

Country

Street

City

Region

Postal Code

Is your employer paying for the CEU program?

Yes

No

Other Required Information

Have you ever been found guilty of a misdemeanor, felony or other crime?

Yes

No

If Yes, please explain

Submission of Application

Students will be subject to the policies and procedures of Heidelberg University when participating in Heidelberg programs or when present at Heidelberg facilities.

By clicking Submit (below), I affirm that the information presented in my application is complete and accurate to the best of my knowledge. I understand that any intentional omission or misrepresentation of information on this form could result in denial of admission or dismissal from Heidelberg University. I am aware that all transcripts submitted to Heidelberg in support of my application become the property of Heidelberg University.