SCHOOL OF EDUCATION
APPLICATION FOR GRADUATE ADMISSION

Applicants who submit complete application packets and who meet minimum requirements for regular admission will be considered. Acceptance is not guaranteed. The School of Education at Georgia Southwestern State University seeks the most qualified applicants for admission to its graduate degree cohort programs.

All materials submitted in conjunction with an application become the property of Georgia Southwestern State University and will not be returned. Submission of application does not guarantee admission.

(**indicates a mandatory field)

**Admission requested for: (Please Check One)
Fall (August)
Deadline: May 31		 Summer (June)
Deadline: March 15 		Year 20  
 

APPLICANT INFORMATION

Full Legal Name **First (given) Middle **Last
 
Permanent Mailing Address **Street Address Apt No.
 
  **City **State **Zip
 
  County **Telephone (including Area Code) **Email Address
 
Indicate other names used on official
records if different from above:		 First Middle Last
 
Contact in case of emergency Parent      Spouse      Guardian      Other
  First Last Telephone (including Area Code)
 
  Address Apt No.
 
  City State Zip
 
 

**Citizenship:
US Citizen by birth Resident Alien (copy of green card required)
Non-Resident Alien
Country of Citizenship (if not US)
Visa Type
 

ARE YOU APPLYING FOR IN-STATE TUITION?

 Yes No
Residency Status:  

**Legal Resident of Georgia?

Yes  If yes, how long?   (Years) (Months)   County
No  If no, legal state of residency
Have you established and maintained legal residence in Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term in which you plan to enroll?
Yes
No
Have you ever lived outside of the state of Georgia?
Yes
No

If you have ever lived outside the state of Georgia and now live in Georgia, how long have you continuously lived in the state of Georgia at this time?

  (Years) (Months)  

Did you (or your parents if you are claimed as a dependant) file a state income tax return this past year?

Yes   No  If yes, in which state did you file?


In accordance with Board of Regents Policy 4.3.4, all applicants who are accepted for admission or readmission to Georgia Southwestern State University for Fall, 2011 or any academic semester thereafter, and who seek to be classified as in-state for tuition purposes, will be required to provide validation of residency and lawful presence in both the State of Georgia and the United States. Acceptance to Georgia Southwestern State University is conditional until lawful presence is verified.

DEMOGRAPHIC INFORMATION

**Birthdate
Place of Birth (City, State)
Gender
Female
Male
Marital Status
Single
Married
Divorced
Widowed
Separated
Ethnic Origin: Please answer the following two questions. (optional)
Are you Hispanic or Latino? Yes No
What is your race? (Choose one or more.)
American Indian or Alaskan Native
Asian or Pacific Islander
Black (Non-Hispanic Origin) or African American
Native Hawaiian or Other Pacific Islander
White (Non-Hispanic Origin)
 

ACADEMIC INFORMATION

**Classification:  Regular Admission
Master of Education in Curriculum and Instruction
Early Childhood Track
Special Education Track
General Content Education Track
Education Specialist in Teacher Leadership
Early Childhood Track
Special Education Track
General Content Education Track

 
**Classification:  Non-Degree Admission
Post Baccalaureate (certification renewal, increase gpa, personal development, special projects, etc.) Purpose:
Transient
 

 

List all colleges and universities you have attended or are attending, including Georgia Southwestern State University. Official transcripts are required from each institution. If you are currently enrolled, give the last expected date of enrollment.
Name of Institution Attendance From (mm/yy) Attendance To (mm/yy) Degree Earned (mm/yy)

Each applicant seeking regular admission to the Education Specialist (EdS) must submit acceptable scores on the GRE. All test scores must be requested by the student and mailed from the testing agency directly to: Georgia Southwestern State University, 800 Wheatley St. Americus, GA 31709.

Scores (no more than 5 years old) will be submitted from:
(Not required for Master's Degree)		 GRE Date taken or scheduled (mm/dd/yy)

 

** I understand that any material false statement made knowingly and willfully by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution. Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.
Yes, I agree No, I do not agree. Do not process my application Date: 
Signature ______________________________________________