New Open Classes Program

Please fill in the fields below. Submit the following application form, along with the $75.00 (non-fundable) application fee.

First Name

Preferred Name

If you prefer to be called by a name other than your first name, enter it here.

Last Name

Degree

Bachelors (BA,BS)

Masters (MA, MS, MSW, MEd)

Doctorate (PhD, PsyD)

Medical Doctor (MD, DO)

Email

Street

City

State/Province

Zip/Postcode

Country

Cell Phone

If you live outside the Chicago area, please choose YES to being a Distance Student.

Country of Citizenship

Distance Student

Yes No Not Selected

How did you learn about us?

Internet Search/Institute Website

Prior or Current Student

Continuing Education Event

Open House

Colleague or Referral

Radio Advertisement

Email Advertisement

Birth Date

Ethnicity

Gender

Other Gender Identities

If you identify as something other than man or woman, enter your identity/pronouns in this field.

Brief Personal Statement

Curriculum Vitae/Resume

Auto Charge?

Yes No Not Selected

Enter the above code

Required