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		 Spring (Jan)
Deadline: Oct. 15 		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 Resident Alien (copy of green card required)
Non-Resident Alien
Country of Citizenship (if not US)
Visa Type
**Residency Status:  Legal Resident of Georgia?
Yes  If yes, how long?   (Years) (Months)   County
No  If no, legal state of residency
 

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 Learning and Leading
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)
 

 

**I certify all statements made in this application are complete and true. I also understand that falsification of, or failure to provide information requested, may result in my immediate dismissal and/or loss of all credits from the University. If my application is accepted and I become a student, I agree to abide by the published regulations of the University and the policies of the Board of Regents of the University System of Georgia.
Yes, I agree No, I do not agree. Do not process my application Date: 
Signature ______________________________________________