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First & Middle Name*

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Address*

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Work Number

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Emergency Contact Information (Other Than Parent)

Legal Last Name

Legal First Name

Relationship

Cell/Home Number

Address

Street Address City State / Province / Region ZIP / Postal Code

Today's Date*

Signature*

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Consent*

I hereby acknowledge that I am making an application to apply for admission at Fremont University and have received an application packet. The application packet fee is $25.00 and is non-refundable. I understand that receiving this material does not obligate me to attend Fremont University, nor does this guarantee that I will be accepted to Fremont University.

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I agree to receive SMS Text Messages at the above phone number from Fremont University for follow-up purposes related to education programs. Message and data rates may apply. Message frequency varies. Text HELP for help. Text STOP to cancel. See Privacy Policy.

On the next screen you’ll have the option to pay the $25 application fee today with a credit card or choose to pay later by phone or with cash.

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