Data Collection Form-Employee






Home Address:
   
   
   

Citizenship

Phone numbers:
   
   
   

Gender
Marital Status

Ethnic (we are required to request this information by Federal Statute)
Religious Denomination:
Are you seeking a degree?:
Degree Already Earned?:
              
Year & College where degree was earned
   
   
   
Have you ever taken any classes through the university (this includes Continuing Education, Lifelong Learning, Wilmar-Extension, Newman Center Extension, Military Science, SJU Prep School Progroam, St. Cloud Hospital School of Nursing, or Special Diocese)
     

Courses Requested
























Alternate Courses to be considered if your first choice is unavailable