Application For Admission Under The Agreement On Graduate Education
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1
2Application for Admission under the Agreement on Graduate Education – The University of
Missouri-Kansas City (UMKC), the Board of Regents of the State of Kansas, and the University
of Kansas Medical Center (KUMC)
Students are enrolled at both the home and host institution, and pay tuition and fees at the host institution for the course(s) enrolled in
under this agreement. Students enrolling at KUMC will receive instructions about how to access the KUMC network/email account via
the email address listed on this application. Once they have a KUMC email account, the student is responsible for enrolling themselves
in the class at Enroll and Pay (https://sa.ku.edu). Students enrolling at UMKC pay tuition/fees at the Cashier’s Office, 112
Administrative Center or online through the UMKC website.
Deadlines for submitting applications are: August 1 - Fall Semester, December 1 - Spring Semester, May 1 - Summer
Session.
It is the student’s responsibility to request and pay for a transcript to be sent from the host institution to the home institution
if needed.
Student completes this section
Make sure all sections are completed and print clearly:
.
Social Security Number
Student # Home Institution
Student # Host Institution
(to be completed by Host Institution)
Name
Last
First
Middle
Maiden
Current Address
No & Street
Apt. #
City
State
Zip
Phone (
)
E-Mail Address
Date of Birth
Mo/Day/Year
Are you an international Student?
YES
NO
Citizenship/country
Visa Type (if applicable)
Signature of Representative from Home institutions International Student Office for students on a Visa:
Date
Print name of representative from International Student Office
Degree(s) sought: at home institution
ENROLLMENT REQUESTED FOR:
Department at home institution
_____FALL 20_______
_____SPRING 20 _______
* This agreement includes all graduate degree programs excluding MD.
_____SUMMER 20 _______
UKMC students attending at least one course at KUMC must complete the following requirements and obtain
the appropriate signatures prior to presenting an application to the KUMC Office of the Registrar (CRNA
Students should report to Truman Medical Center Occupational Health Center for Health Requirements):
Signature of KUMC Student Health Representative*:
(1012 Student Center)
Date:
* Students are required to submit immunization, health history, and physical examination records. Contact Student Health at 913-588-
1941 or
Signature of Health Insurance Representative*:
(G112 Student Center)
Date:
* Students must provide proof of health insurance. For more details, go to the health insurance website at
Note: I understand that my enrollment in the course(s) shown on this form is subject to the availability of class space at the
time of my registration and I am responsible for all tuition and fees assessed by the host institution.
Student Signature
Date
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