California University of Pennsylvania. Application for Admission School of Graduate Studies and Research

Size: px
Start display at page:

Download "California University of Pennsylvania. Application for Admission School of Graduate Studies and Research"

Transcription

1 California University of Pennsylvania Application for Admission School of Graduate Studies and Research 250 University Avenue California, PA Phone: Fax:

2 California University School of Graduate Studies Codes Areas of Specialization California University of Pennsylvania offers graduate work in the following areas of specialization: Master of Education 0115 Elementary Education (with cert.) 0118 Elementary Education (w/o cert.) 0119 Elementary/Special Education Dual Certification 0143 Mentally/Physically Handicapped 0150 Reading Specialist 0151 School Counseling Master of Arts Teaching 0501 English* 0521 Art* 0525 Communications* 0530 Physics* 0533 French* 0540 Spanish* 0548 Math * 0560 Biology* 0563 Earth Science* 0580 Social Studies* 0590 Chemistry* * For persons seeking INITIAL CERTIFICATION Master of Social Work 0350 Master of Social Work 0800 Non-Degree For those students who are not in a degree program or wish to take courses for personal Enrichment, permanent certification, master s Equivalency or for transfer. Master of Science 0330 Athletic Training 0325 Business Admin 0303 Communication Disorders 0320 Community and Agency Counseling 0310 School Psychology Certification Programs 0415 Elementary Education 0443 Mentally/Physically Handicapped 0157 School Counseling 0910 Reading 0410 School Psychology Post Mater s Certification 0701 School Counseling Certificate 0444 Autism Spectrum Disorders Cal U Global Online Master of Arts Teaching 0975 Advanced studies in Sec. Ed. (certified teachers only) Master of Science Legal Studies 0953 Homeland Security 0955 Law and Public Policy 0957 Criminal Justice Exercise Science and Health Promotion 0952 Wellness & Fitness 0954 Perform. Enhance. & Injury Prevention 0956 Rehabilitation Sciences 0958 Sport Psychology Sport Management 0962 Intercollegiate Athletic Admin Sport Management Generalist 0964 Sports Counseling Masters of Ed. In Elementary Ed National Board Teacher Cert 0903 Early Childhood Education 0904 Eng. as a Sec. Lang Certificate 0455 Superintendent s Letter of Eligibility Post Master s Certificate Exercise Science 0992 Wellness & Fitness 0994 Performance Enhancement and Injury Prevention 0996 Rehabilitation Science 0998 Sport Psychology Post Bachelor s Certificate Sport Management 0981 Intercollegiate Athletic Administration 0935 Sports Counseling Tourism Planning & Development 0925 Tourism Planning & Development Masters Science in Nursing 0930 Nursing Admin. & Leadership Master of Education 0976 K-12 Principal-Online 0915 Technology Education Certification Programs Online 0977 K-12 Principal Certificate 0911 Early Childhood Ed. Cert.

3 California University School of Graduate Studies Codes Present Military Status Ethnicity Race Codes 1 Non-Veteran H-Hispanic/Latino 2 Active Reserve A person of Cuban, 3 Inactive Reserve Mexican, Puerto Rican, 4 Duty Completed South or Central Amer., 5 Active Duty or other Spanish culture Or origin, regardless of race. N-Not Hispanic/Latino 2 Alaskan Native/American Indian A person having origins in any of the original Peoples of North & South America (including Central America), And who maintains tribal affiliation or community attachment. 3 Asian A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including for example, Cambodia, China, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam 4 Black/African American A person having origins in any of the black racial groups of Africa 5 Native Hawaiian/Pacifica Islander A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands 6 White A person having origins in any of the original peoples of Europe, the Middle East, or North Africa LIST OF PENNSYLVANIA COUNTIES BY CODE 01 Adams 09 Bucks 17 Clearfield 25 Erie 33 Jefferson 41 Lycoming 49 Northumberland 57 Sullivan 65 Westmoreland 02 Allegheny 10 Butler 18 Clinton 26 Fayette 34 Juniata 42 McKean 50 Perry 58 Susquehanna 66 Wyoming 03 Armstrong 11 Cambria 19 Columbia 27 Forest 35 Lackawanna 43 Mercer 51 Philadelphia 59 Tioga 67 York 04 Beaver 12 Cameron 20 Crawford 28 Franklin 36 Lancaster 44 Mifflin 52 Pike 60 Union 98 Foreign 05 Bedford 13 Carbon 21 Cumberland 29 Fulton 37 Lawrence 45 Monroe 53 Potter 61 Venango 99 Out-of-State 06 Berks 14 Centre 22 Dauphin 30 Greene 38 Lebanon 46 Montgomery 54 Schuylkill 62 Warren 07 Blair 15 Chester 23 Delaware 31 Huntingdon 39 Lehigh 47 Montour 55 Snyder 63 Washington 08 Bradford 16 Clarion 24 Elk 32 Indiana 40 Luzerne 48 Northampton 56 Somerset 64 Wayne

4 School of Graduate Studies and Research California University of Pennsylvania 250 University Avenue California, PA Phone Fax: Application for Admission to the School of Graduate Studies and Research 1. This form must be completed by all who expect to enroll in graduate studies at California University of Pennsylvania. 2. A nonrefundable $25 application fee must accompany this form. (Checks should be payable to California University of Pennsylvania.) 3. Official transcripts from all colleges and universities are required. Transcripts from California University of Pennsylvania are not required. 4. Incomplete applications will not be processed. *Indicates optional information Name Social Security Number Last First Middle Maiden Name Temporary Address Street City State Zip Residence Dates From: To: Permanent Address Street City State Zip address County (see code sheet) Country Home Phone Work Phone Sex* Male Female Race* (see code sheet) Ethnicity* (see code sheet) D/O/B Military Service Yes No If yes, present status (see code sheet) U.S. Citizen Yes No Legal Resident of PA Yes No Which location will you primarily attend? California Southpointe Other (indicate location) RET CaluGO Curriculum in which you desire to enroll (see code sheet) M.A.T. (Must have passed Praxis I) M.Ed. M.A. M.S. M.S.W. Post-Masters Certification Only Non-Degree Special Workshops Semester you plan to enroll Fall Spring Summer Year Have you been expelled or dismissed from a college or university? Yes No If yes, please explain on a separate sheet of paper.

5 Services for Students with Disabilities: The Office for Students with Disabilities provides services to students with disabilities. Call for information about application procedures, services and required documentation. Students are encouraged to contact the Office for Students with Disabilities prior to arriving on campus. I understand that the above statements are true to the best of my knowledge. Any false information may be used as grounds for denial or dismissal. I also realize that credentials filed in support of this application become the final property of California University of Pennsylvania. Signature Date Have you attended graduate school previously? Where? Number of credits earned Purpose of graduate study at Cal U Permanent Certification Transfer Purposes Degree Master s Equivalent Other Type of teaching certificate held Date issued Issued by what state Undergraduate Study Colleges or Universities Name and Location Dates Attended Course Taken/Major/Minor Degree Month & Year Graduate Study Colleges or Universities NOTE: If you do not register within one year of acceptance, you must reapply. In order to finalize your graduate application, you must put an X in ONE of the boxes below. I certify that I will not be enrolled in another program of study at another institution(s) while enrolled in a graduate program of study at California University of PA. I certify that I will be enrolled in another program of study at another institution(s) while enrolled in a graduate program of study at California University. In addition, I acknowledge that I will not be eligible for federal financial aid at California University of PA if I receive federal financial aid from the other institution(s). I understand that if California University discovers at a later date that I am receiving aid at another institution while receiving federal financial aid at California University of PA, my federal financial aid at California University of PA will be cancelled immediately and I will be liable for repayment of those federal aid funds I received. Lastly, I understand that failure to repay those dollars within 30 days will result in the University referring my account to the federal government for collection. NONDISCRIMINATION POLICY California University of Pennsylvania is an academic community dedicated to the ideals of justice, fairness and equal opportunity for all. In compliance with federal and state laws, the university is committed to providing equal educational and employment opportunities for all persons without regard to race, color, sex, religion, national origin, age, disability, ancestry, sexual orientation, or status as a disabled or Vietnam-era veteran. The university will not tolerate racial, ethnic or sexual discrimination. Sexual harassment is considered by law to be a form of sexual discrimination and is, therefore, unacceptable. Direct equal opportunity and affirmative action inquires or complaints to the Special Assistant to the President for EEEO/University Ombudsperson, Office of Social Equity, South Hall 112, Direct inquiries regarding services or facilities accessibility to the ADA/504 Compliance Officer, Office for Students with Disabilities, Residence Hall B, Direct Title IX inquiries to the Senior Women s Administrator/Title IX Coordinator, Department of Athletics, Hamer Hall 248,

FALLS AND FALL-RELATED INJURIES

FALLS AND FALL-RELATED INJURIES The number of resident deaths due to falls and fall-related injuries was 71 in 1995 which was 13 more deaths than reported for 1985 (38). However, the age-adjusted death rate has not changed much over

More information

PENNSYLVANIA DEPARTMENT OF REVENUE REALTY TRANSFER TAX COMMON LEVEL RATIO (CLR) REAL ESTATE VALUATION FACTORS FOR ADAMS COUNTY CLR FACTOR

PENNSYLVANIA DEPARTMENT OF REVENUE REALTY TRANSFER TAX COMMON LEVEL RATIO (CLR) REAL ESTATE VALUATION FACTORS FOR ADAMS COUNTY CLR FACTOR COMMON LEVEL RATIO () REAL ESTATE VALUATION S ADAMS COUNTY 7-2-1986 6-30-1987 7.94 7-1-2006 6-30-2007 3.98 7-1-1987 6-30-1988 9.01 7-1-2007 6-30-2008 4.53 7-1-1988 6-30-1989 9.35 7-1-2008 6-30-2009 4.55

More information

HD0344P 2013 ABORTION STATISTICS

HD0344P 2013 ABORTION STATISTICS HD0344P 2013 ABORTION STATISTICS 2013 ABORTION STATISTICS In 2013, there were 32,108 abortions performed in Pennsylvania. The 2013 figure is a 51.2 percent decrease from the 1980 total of 65,777 (the highest

More information

CANCER of the CORPUS UTERI

CANCER of the CORPUS UTERI CANCER of the CORPUS UTERI Data Highlights The average annual (1994-98) age-adjusted incidence rate for cancer of the corpus uteri among whites was over 56 percent higher than the rate for blacks (25.6

More information

The Commonwealth s Official Source for Population and Economic Statistics. March 9, 2011

The Commonwealth s Official Source for Population and Economic Statistics. March 9, 2011 Research Brief The Commonwealth s Official Source for Population and Economic Statistics March 9, 2011 Local Data Released for Pennsylvania: State Shows Continued Population Growth PENN STATE HARRISBURG

More information

A Snapshot of Pennsylvania s Uninsured Selected Findings from the 2008 Pennsylvania Insurance Department Health Insurance Survey

A Snapshot of Pennsylvania s Uninsured Selected Findings from the 2008 Pennsylvania Insurance Department Health Insurance Survey Size A Snapshot of Pennsylvania s Selected Findings from the 2008 Pennsylvania Insurance Department Health Insurance Survey The Pennsylvania Health Access Network Harrisburg, PA 17101 www.pahealthaccess.org

More information

The Pennsylvania State University Student Parent Child Care Subsidy Application and Information Form

The Pennsylvania State University Student Parent Child Care Subsidy Application and Information Form Office of Human Resources The Pennsylvania State University 321 James M. Elliott Building University Park, PA 16802-5032 Please note that this form has been updated to reflect changes for our new CCAMPIS

More information

Please read this letter

Please read this letter Please read this letter December 21, 2009 Dear Family, We are writing this update about Pennsylvania s new Autism Insurance Law. (also known as Act 62). This law requires certain private health insurance

More information

Nursing Opportunities by County. View the county of your choice below to see a list of nursing job classifications used by facilities in that county.

Nursing Opportunities by County. View the county of your choice below to see a list of nursing job classifications used by facilities in that county. Nursing Opportunities by County View the county of your choice below to see a list of nursing job classifications used by facilities in that county. Please note that not all counties have nursing facilities.

More information

Understanding MATP: The Medical Assistance Transportation Program

Understanding MATP: The Medical Assistance Transportation Program Understanding MATP: The Medical Assistance Transportation Program Prepared by the Pennsylvania Health Law Project Helpline: (800)274-3258 1-866-236-6310 TTY Website: www.phlp.org Copyright 2009 Pennsylvania

More information

DEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE

DEVELOPMENTAL PROGRAMS BULLETIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE DEVELOPMENTAL PROGRAMS BULLIN COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE DA OF ISSUE December 29, 2011 EFFECTIVE DA July 1, 2011 NUMBER 00-11-09 SUBJECT: Medical Assistance Program Fee Schedule

More information

Pennsylvania s Health Care Marketplace

Pennsylvania s Health Care Marketplace Pennsylvania s Health Care Marketplace Rating Areas: Insurance plans and their cost vary across the state. Pennsylvania is divided into nine rating areas. Rating areas are the geographic component used

More information

Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010

Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010 This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make available Plans

More information

Recent Graduate. Q1 Which program did you graduate from? CWEB (1) CWEL (2) Answer Q2-Q10 If Q1 =CWEL

Recent Graduate. Q1 Which program did you graduate from? CWEB (1) CWEL (2) Answer Q2-Q10 If Q1 =CWEL Recent Graduate Q1 Which program did you graduate from? CWEB (1) CWEL (2) Answer Q2-Q10 If Q1 =CWEL Q2 Have you taken the LSW/LCSW examination? Yes (1) No (2) Answer Q3 If Q2 =Yes Q3 Did you pass the LSW/LCSW

More information

Understanding Wraparound Services for Children in HealthChoices

Understanding Wraparound Services for Children in HealthChoices Understanding Wraparound Services for Children in HealthChoices Everyone on Medical Assistance (MA) has an ACCESS card. Most people on MA now receive mental health and drug & alcohol services from a Behavioral

More information

CREDIT ENROLLMENT TRENDS

CREDIT ENROLLMENT TRENDS CREDIT ENROLLMENT TRENDS Fall 2015 Heads 4000 3500 3000 3120 3116 3180 3150 3452 2500 2000 1500 1000 500 0 2011 2012 2013 2014 2015 Institutional Research October 2015 Credit Enrollment Trends Fall 2015

More information

Pennsylvania Census Snapshot: 2010

Pennsylvania Census Snapshot: 2010 Pennsylvania Census Snapshot: 2010 22,336 Husband/wife 3,228 Unmarried partner 19,108 per 1,000 households Same-sex husband/wife per 1,000 husband/wife Same-sex unmarried partner per 1,000 unmarried partner

More information

[41 Pa.B. 6163] [Saturday, November 12, 2011]

[41 Pa.B. 6163] [Saturday, November 12, 2011] 1 of 10 11/15/2011 11:17 AM Medical Assistance Program Fee Schedule for Consolidated and Person/Family Directed Support Waiver-Funded Select Services, Targeted Service Management and Community Mental Retardation

More information

ASSISTIVE TECHNOLOGY AND TITLE II AND TITLE III OF THE AMERICANS WITH DISABILITIES ACT (ADA)

ASSISTIVE TECHNOLOGY AND TITLE II AND TITLE III OF THE AMERICANS WITH DISABILITIES ACT (ADA) ASSISTIVE TECHNOLOGY AND TITLE II AND TITLE III OF THE AMERICANS WITH DISABILITIES ACT (ADA) Figure 1: Door knob and key. Prepared by: Disability Rights Network of Pennsylvania www.drnpa.org 1414 N. Cameron

More information

Overview of Presentation

Overview of Presentation Overview of Presentation PA Overview & CWIA Products/Services Workforce Investment Act Cost/Benefit Study Workforce Data Quality Initiative Update Sue Mukherjee Director, Center for Workforce Information

More information

OVR and other state agencies can be accessed through a new 1 stop shop for the PA government on the internet. http://www.cwds.state.pa.

OVR and other state agencies can be accessed through a new 1 stop shop for the PA government on the internet. http://www.cwds.state.pa. Pennsylvania Office of Vocational Rehabilitation Commonwealth of Pennsylvania Department of Labor & Industry OVR and other state agencies can be accessed through a new 1 stop shop for the PA government

More information

Thomas P. Williams Pennsylvania State Director

Thomas P. Williams Pennsylvania State Director Thomas P. Williams Pennsylvania State Director in fra struc ture [in-fruh-struhk-cher] noun The fundamental facilities and systems serving a country, city, or area, as transportation and broadband systems,

More information

Aggressive Transitioning from. ACGME/AOA Teaching Hospital

Aggressive Transitioning from. ACGME/AOA Teaching Hospital Aggressive Transitioning from Community Hospital to ACGME/AOA Teaching Hospital Joseph Stella, DO FACOS Mary Elizabeth Roth, M.D. FACPE, Linda Famiglio, M.D., John Bulger, DO Geisinger Health System Academic

More information

Lawyer Referral Services by County

Lawyer Referral Services by County s by County Adams ADAMS COUNTY ADAMS COUNTY COURTHOUSE GETTYSBURG 17325 717-337-9846 Allegheny ALLEGHENY COUNTY ALLEGHENY COUNTY BAR ASSOCIATION Koppers Bldg., Suite 400 436 Seventh Avenue Pittsburgh,

More information

IssuesPA Workforce Poll: 10 Major Findings (9/30/05)

IssuesPA Workforce Poll: 10 Major Findings (9/30/05) IssuesPA Workforce Poll: 10 Major Findings (9/30/05) 1. Most Pennsylvanians see the job situation in their region of state as only fair, at best. Job Situation in Own Area of State Excellent/Good Only

More information

Interim Final FORM 1: Total Coliform Sample Siting Plan Form Instructions

Interim Final FORM 1: Total Coliform Sample Siting Plan Form Instructions COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF SAFE DRINKING WATER Interim Final FORM 1: Total Coliform Sample Siting Plan Form For Noncommunity Water Systems Collecting

More information

Information 117 Baltimore Street Gettysburg, PA 17325 (717) 337-9834. Court Administrator Adams County Courthouse Gettysburg, PA 17325 717-337-9846

Information 117 Baltimore Street Gettysburg, PA 17325 (717) 337-9834. Court Administrator Adams County Courthouse Gettysburg, PA 17325 717-337-9846 County ADAMS ALLEGHENY ARMSTRONG BEAVER BEDFORD BERKS BLAIR BRADFORD BUCKS BUTLER Office to List on Notice to Defend Office of the, Room 104, Adams County, Gettysburg, Pennsylvania 17325. Department of

More information

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING. Accelerated Bachelor s Program for Non-Nurses

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING. Accelerated Bachelor s Program for Non-Nurses UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Bachelor s Program for Non-Nurses Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing.

More information

IWG Pilot Certification & Testing Program. Tuesday, March 3, 2015

IWG Pilot Certification & Testing Program. Tuesday, March 3, 2015 IWG Pilot Certification & Testing Program Tuesday, March 3, 2015 Hear today: - The Case for Interoperability - Three trusted brands : One powerful program - IWG Certification Specifics - Learn how to move

More information

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Masters Program for Non-Nurses

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Masters Program for Non-Nurses UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Accelerated Masters Program for Non-Nurses Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing.

More information

A Parent s Guide to Choosing Quality Child Care

A Parent s Guide to Choosing Quality Child Care A Parent s Guide to Choosing Quality Child Care Building relationships with families to encourage development of Pennsylvania s children and stability of care for Pennsylvania s families. We believe in

More information

BID ITEM WORKBOOK COSTARS-6 Software BIDDER/CONTRACTOR DATA

BID ITEM WORKBOOK COSTARS-6 Software BIDDER/CONTRACTOR DATA BIDDER/CONTRACTOR DATA BIDDER/CONTRACTOR'S LEGAL NAME: D/B/A NAME, IF APPLICABLE: BIDDER ADDRESS: COUNTY LOCATED IN: VENDOR NUMBER: PA Legislative House District Number DGS Self-Certified Small Business

More information

HEALTHCHOICES BEHAVIORAL HEALTH PERFORMANCE-BASED CONTRACTING REPORT 2011 COMMONWEALTH OF PENNSYLVANIA MARCH 20, 2012

HEALTHCHOICES BEHAVIORAL HEALTH PERFORMANCE-BASED CONTRACTING REPORT 2011 COMMONWEALTH OF PENNSYLVANIA MARCH 20, 2012 PERFORMANCE-BASED CONTRACTING REPORT 2011 MARCH 20, 2012 CONTENTS 1. Stakeholder introduction... 1 2. Executive summary... 5 3. Access performance indicators... 7 4. Quality of process performance indicators...

More information

2014 Rankings. Pennsylvania

2014 Rankings. Pennsylvania 2014 Rankings Pennsylvania INSIDE FRONT COVER INTENTIONALLY BLANK INTRODUCTION The County Health Rankings & Roadmaps program helps communities identify and implement solutions that make it easier for people

More information

University Of Rochester School of Nursing. Leadership in Health Care Systems Masters Program Clinical Nurse Leader

University Of Rochester School of Nursing. Leadership in Health Care Systems Masters Program Clinical Nurse Leader University Of Rochester School of Nursing Leadership in Health Care Systems Masters Program Clinical Nurse Leader Thank you for your interest in the University of Rochester School of Nursing Clinical Nurse

More information

FACT SHEET. Instructions for Completing Form MV-4ST, Vehicle Sales and Use Tax Return/Application for Registration

FACT SHEET. Instructions for Completing Form MV-4ST, Vehicle Sales and Use Tax Return/Application for Registration FACT SHEET Instructions for Completing Form MV-4ST, Vehicle Sales and Use Tax Return/Application for Registration (FOR PENNDOT AUTHORIZED AGENTS USE ONLY) This form is used to obtain a Pennsylvania Certificate

More information

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING RN to BS Program Web Page Address: www.son.rochester.edu

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING RN to BS Program Web Page Address: www.son.rochester.edu UNIVERSITY OF ROCHESTER SCHOOL OF NURSING RN to BS Program Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing combined RN to BS Program

More information

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Nurse Practitioner Masters Program Web Page Address: www.son.rochester.edu

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Nurse Practitioner Masters Program Web Page Address: www.son.rochester.edu UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Nurse Practitioner Masters Program Web Page Address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing Nurse Practitioner

More information

METHODS USED TO ASSURE TRANSPORTATION OF BENEFICIARIES TO AND FROM PROVIDERS

METHODS USED TO ASSURE TRANSPORTATION OF BENEFICIARIES TO AND FROM PROVIDERS Page 1 Transportation of beneficiaries to and from providers of services is available in two categories: ambulance and non-ambulance. Coverage of ambulance transportation is limited to the transportation

More information

Rising STARS Tuition Assistance Program Application (Effective July 1, 2014)

Rising STARS Tuition Assistance Program Application (Effective July 1, 2014) PA Keys to Professional Development c/o BCIU P.O. Box 16050 Reading, PA 19612-6050 FAX: 610-987-8400 Rising STARS Tuition Assistance Program Application (Effective July 1, 2014) INSTRUCTIONS: Complete

More information

Pennsylvania Commission on Crime and Delinquency

Pennsylvania Commission on Crime and Delinquency Juvenile Justice and Delinquency Prevention Program Profile Welcome to the Pennsylvania Juvenile Justice Program Profile. The Program Profile is a series of questions where service providers and juvenile

More information

Pittsburgh, PA (412) FAX - (412) th Avenue Suite 402

Pittsburgh, PA (412) FAX - (412) th Avenue Suite 402 County Address & Phone Numbers 01 - Adams P.O. Box 4446 225 South Franklin Street Gettysburg, PA 17325-4446 (717) 334-6241 1-800-638-6816 FAX - (717) 334-4104 02 - Allegheny Piatt Place 301 5th Avenue

More information

NON-DEGREE STUDENT APPLICATION PROCESS

NON-DEGREE STUDENT APPLICATION PROCESS NON-DEGREE STUDENT APPLICATION PROCESS Thank you for your interest in taking classes as a non-degree student at St. Mary s College of Maryland. Individuals who wish to take a limited number of credit classes

More information

EMPLOYMENT APPLICATION An Equal Opportunity Affirmative Action Employer

EMPLOYMENT APPLICATION An Equal Opportunity Affirmative Action Employer Waukesha County Technical College 800 Main Street, Pewaukee, WI 53072 EMPLOYMENT APPLICATION An Equal Opportunity Affirmative Action Employer Position(s) Applied For Full Time Part Time Name Last First

More information

CONTACT: FOR IMMEDIATE RELEASE

CONTACT: FOR IMMEDIATE RELEASE NEWS RELEASE CONTACT: Steve Schell, Communications Coordinator FOR IMMEDIATE RELEASE 717-795-2000 ext. 3269 E-mail steve.schell@pacourts.us WWW.COURTS.STATE.PA.US Statewide Criminal Court Computer Systems

More information

APPLICATION FOR STUDENT EMPLOYMENT

APPLICATION FOR STUDENT EMPLOYMENT LAST NAME FIRST MIDDLE INITIAL APPLICATION FOR STUDENT EMPLOYMENT N-0613 (03-13) An Equal Opportunity Employer IT IS IMPORTANT TO NOTE THAT THIS APPLICATION IS FOR STUDENT EMPLOYMENT ONLY. We realize the

More information

NON-DEGREE/SPECIAL STUDENT ENROLLMENT

NON-DEGREE/SPECIAL STUDENT ENROLLMENT NON-DEGREE/SPECIAL STUDENT ENROLLMENT Enrolling as a non-degree student enables a person to take one or two graduate level social work courses per term in order to help focus their interests, to test capabilities

More information

Johns Hopkins University School of Medicine. Application for Postdoctoral Research Fellowship Training

Johns Hopkins University School of Medicine. Application for Postdoctoral Research Fellowship Training Johns Hopkins University School of Medicine Application for Postdoctoral Research Fellowship Training General Instructions for Completion of this Application Each section must be complete and legible or

More information

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Instructions for Applicants to the PhD Program Web page address: www.son.rochester.edu The University of Rochester School of Nursing uses a self-managed application

More information

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING

UNIVERSITY OF ROCHESTER SCHOOL OF NURSING UNIVERSITY OF ROCHESTER SCHOOL OF NURSING Instructions for Applicants to the DNP Program Web page address: www.son.rochester.edu Thank you for your interest in the University of Rochester School of Nursing

More information

P E N N S Y L V A N I A

P E N N S Y L V A N I A B A S I C R E Q U I R E M E N T S : P E N N S Y L V A N I A PAPER: NON-STANDARD FEE: MARGINS: NO MARGIN REQUIREMENTS FOR: CRAWFORD, BUTLER, WASHINGTON, INDIANA, DELAWARE WESTMORELAND OR JEFFERSON PRINT:

More information

Fact Sheet Commonwealth of Pennsylvania Department of Environmental Protection

Fact Sheet Commonwealth of Pennsylvania Department of Environmental Protection Fact Sheet Commonwealth of Pennsylvania Department of Environmental Protection ASBESTOS PROGRAM FOR CONTRACTORS WORKING IN PENNSYLVANIA The Pennsylvania asbestos program includes federal and state regulations

More information

SOUTHEASTERN TECHNICAL INSTITUTE

SOUTHEASTERN TECHNICAL INSTITUTE SOUTHEASTERN TECHNICAL INSTITUTE COSMETOLOGY CULINARY ARTS HEATING, VENTILATION AND AIR CONDITIONING APPLICATION FOR ACADEMIC YEAR 2016-2017 250 Foundry Street South Easton, MA 02375 Phone: 508.238.1860

More information

SOUTHEASTERN TECHNICAL INSTITUTE

SOUTHEASTERN TECHNICAL INSTITUTE SOUTHEASTERN TECHNICAL INSTITUTE DENTAL ASSISTING MEDICAL ASSISTING APPLICATION FOR ACADEMIC YEAR 201 6-2017 250 Foundry Street South Easton, MA 02375 Phone: 508.238.1860 Website: www.stitech.org Southeastern

More information

NAME: LAST NAME FIRST NAME MIDDLE INITIAL

NAME: LAST NAME FIRST NAME MIDDLE INITIAL JOHNSTON PUBLIC SCHOOLS 10 Memorial Avenue Johnston, Rhode Island 02919 Phone: 401-233-1900 / Fax: 401-233-1907 www.johnstonschools.org FULL TIME PART TIME SUBSTITUTE APPLICAT ION FO R EM PLOYM ENT C ER

More information

OMHSAS Staff Contact Information

OMHSAS Staff Contact Information OMHSAS Staff Contact Information Executive Council Joan L. Erney J. D., Deputy Secretary Office of Mental Health & Substance Abuse Services P. O. Box 2675 OMHSAS Receptionist: 717-787-6443 Responsible

More information

ATTORNEY APPLICATION FOR EMPLOYMENT DIVISION OF LAW DEPARTMENT OF LAW AND PUBLIC SAFETY STATE OF NEW JERSEY

ATTORNEY APPLICATION FOR EMPLOYMENT DIVISION OF LAW DEPARTMENT OF LAW AND PUBLIC SAFETY STATE OF NEW JERSEY ATTORNEY APPLICATION FOR EMPLOYMENT DIVISION OF LAW DEPARTMENT OF LAW AND PUBLIC SAFETY STATE OF NEW JERSEY The Division of Law provides legal counsel and representation to agencies of State government

More information

UNDERGRADUATE TEACHER CERTIFICATION ENROLLMENT FORM

UNDERGRADUATE TEACHER CERTIFICATION ENROLLMENT FORM UNDERGRADUATE TEACHER CERTIFICATION ENROLLMENT FORM ELED, SPED and ECED are not available through the Teacher s Certification program. For any K 12 programs listed below, please seek advising from the

More information

LINCOLN SCHOOL DISTRICT 156 410 157 th Street Calumet City, Illinois 60409-4798

LINCOLN SCHOOL DISTRICT 156 410 157 th Street Calumet City, Illinois 60409-4798 LINCOLN SCHOOL DISTRICT 156 410 157 th Street Calumet City, Illinois 604094798 Dear Applicant: APPLICATION FOR EMPLOYMENT FOR CERTIFIED PERSONNEL We welcome your application for employment in Lincoln Elementary

More information

Employment Application

Employment Application Employment Application Please complete application in full and answer all questions completely. Type or print legibly. Indicate N/A if not applicable. Do not indicate See Résumé. A résumé may be attached

More information

UNDERGRADUATE NON-DEGREE ENROLLMENT FORM

UNDERGRADUATE NON-DEGREE ENROLLMENT FORM UNDERGRADUATE NON-DEGREE ENROLLMENT FORM UNDERGRADUATE STUDENTS ONLY: You WILL NOT be eligible for non-degree enrollment if any of the following statements apply to you. If you have: n Previously attended

More information

Last Name First M.I. Date. Street Address Apartment/Unit # License Number: License Expiration Date:

Last Name First M.I. Date. Street Address Apartment/Unit # License Number: License Expiration Date: Employment Application Please note: The information you enter on this form cannot be saved. After completing this form, print and provide an original signature before submitting it as application for a

More information

CAMPUS ADMISSIONS APPLICATION

CAMPUS ADMISSIONS APPLICATION FORM 19-18 ASHFORD UNIVERSITY CAMPUS ADMISSIONS APPLICATION 2011/12 ACADEMIC YEAR I will be attending: Full-Time Part-Time Commuter Resident Freshman Transfer Student 1 Personal Information Start Date:

More information

Jim Lee, President. All Media and Interested Parties. PA Presidential Statewide Poll Results. DATE: October 8, 2012

Jim Lee, President. All Media and Interested Parties. PA Presidential Statewide Poll Results. DATE: October 8, 2012 10 N. Progress Avenue Harrisburg, PA 17109 Phone: (717) 233-8850 Cell Phone: (717) 215-1122 Email: james@susquehannapolling.com www.susquehannapolling.com James Lee, President To: FROM: RE: All Media and

More information

INSTRUCTIONS FOR COMPLETING PWS INVENTORY & BRIEF DESCRIPTION FORM (For Use at NCWSs With ONLY Disinfection or No Treatment)

INSTRUCTIONS FOR COMPLETING PWS INVENTORY & BRIEF DESCRIPTION FORM (For Use at NCWSs With ONLY Disinfection or No Treatment) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF ENVIRONMENTAL PROTECTION BUREAU OF SAFE DRINKING WATER INSTRUCTIONS FOR COMPLETING PWS INVENTORY & BRIEF DESCRIPTION FORM (For Use at NCWSs With ONLY Disinfection

More information

Collection: Hispanic or Latino OR Not Hispanic or Latino. Second, individuals are asked to indicate one or more races that apply among the following:

Collection: Hispanic or Latino OR Not Hispanic or Latino. Second, individuals are asked to indicate one or more races that apply among the following: Overview: The United States Office of Management and Budget (OMB) issued standards for maintaining, collecting, and reporting federal data on race and ethnicity. On October 19, 2007 the Department of Education

More information

APPLICATION FOR EMPLOYMENT INSTRUCTION SHEET

APPLICATION FOR EMPLOYMENT INSTRUCTION SHEET APPLICATION FOR EMPLOYMENT INSTRUCTION SHEET Thank you for your interest in Navarro College. Please take a moment to read the following instructions before completing this application. Please follow the

More information

University of South Dakota Graduate School Graduate Application for Admission

University of South Dakota Graduate School Graduate Application for Admission University of South Dakota Graduate School Graduate Application for Admission GRADUATE APPLICATION INSTRUCTIONS: STUDENTS FROM THE UNITED STATES Thank you for your interest in the University of South Dakota.

More information

Graduate Certificate Application Form and Checklist

Graduate Certificate Application Form and Checklist Graduate Certificate Application Form and Checklist 6530 Haven Hall, 505 South State Street, Ann Arbor, MI 48109 Tel: (734) 615-3275 Email Application to: cogsciprog@umich.edu www.lsa.umich.edu/weinberginstitute

More information

* Required to avoid duplication 2016-2017 Survey of Registered Nurses * Anonymous & aggregate reporting only

* Required to avoid duplication 2016-2017 Survey of Registered Nurses * Anonymous & aggregate reporting only HD1112F Commonwealth of Pennsylvania License #: RN Department of Health * Required to avoid duplication 2016-2017 Survey of Registered Nurses * Anonymous & aggregate reporting only DO NOT MAIL THIS SURVEY

More information

Employment Application An Equal Opportunity Employer

Employment Application An Equal Opportunity Employer Employment Application An Equal Opportunity Employer PO Box 520 76 East Market Street Xenia, Ohio 45385 937-352-4000 The Greene County Public Library considers applications for all positions without regard

More information

Employment Application. Tennessee College of Applied Technology

Employment Application. Tennessee College of Applied Technology Page 1 of 8 Employment Application Tennessee College of Applied Technology Position Applying For: Personal Information: First Name: Middle Name: Last Name: Maiden Name (If applicable): Address: City: State

More information

University of Michigan STUDENT SERVICES: ADMISSIONS

University of Michigan STUDENT SERVICES: ADMISSIONS RACKHAM GRADUATE SCHOOL University of Michigan STUDENT SERVICES: ADMISSIONS 915 E. Washington Street 0120 Rackham Building Ann Arbor, MI 48109-1070 E-Mail: rackadmis@umich.edu www.rackham.umich.edu/prospective-students/admissions

More information

An Equal Opportunity Employer

An Equal Opportunity Employer The ARAMARK Tower 1101 Market Street Philadelphia, Pennsylvania 19107-2994 Howard M. Neukrug, P.E. Commissioner SEWAGE FACILITIES PLANNING FOR DEVELOPMENTS LOCATED WITHIN THE CITY OF PHILADELPHIA The Pennsylvania

More information

PENNSYLVANIA VOTER GUIDE POLLS OPEN 7 A.M. TO 8 P.M. ON ELECTION DAY

PENNSYLVANIA VOTER GUIDE POLLS OPEN 7 A.M. TO 8 P.M. ON ELECTION DAY PENNSYLVANIA VOTER GUIDE POLLS OPEN 7 A.M. TO 8 P.M. ON ELECTION DAY EDWARD G. RENDELL, GOVERNOR PEDRO A. CORTÉS, SECRETARY OF THE COMMONWEALTH A MESSAGE FROM THE GOVERNOR Dear Fellow Pennsylvanian, Voting

More information

Health Care Compliance Certificate

Health Care Compliance Certificate Health Care Compliance Certificate The Health Care Compliance Certificate provides the unique skills needed to guide a health care organization through the complex maze of government laws and regulations.

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT USE ONLY BLACK INK OR TYPEWRITER ON THIS FORM. INCOMPLETE APPLICATION MAY DISQUALIFY YOU FROM FURTHER CONSIDERATION. APPLICATION FOR EMPLOYMENT METROPOLITAN TRANSPORTATION AUTHORITY The MTA is an Equal

More information

THE CENTER FOR. Rural Pennsylvania

THE CENTER FOR. Rural Pennsylvania THE CENTER FOR Rural Pennsylvania A Legislative Agency of the Pennsylvania General Assembly November 2001 A Retrospective of Pennsylvania s Economic Development s 200 North Third St, Suite 600, Harrisburg,

More information

Classified Graduate Admission Application

Classified Graduate Admission Application PLEASE PRINT CLEARLY Classified Graduate Admission Application Send application and fee to: Southern Illinois University Edwardsville Office of Admissions Box 1047 Edwardsville, IL 62026-1047 You may apply

More information

Pennsylvania ehealth Partnership Authority. Health Information Organization Survey. December 2013

Pennsylvania ehealth Partnership Authority. Health Information Organization Survey. December 2013 Pennsylvania ehealth Partnership Authority Health Information Organization Survey December 2013 Pennsylvania ehealth Partnership Authority 613 North Street l Harrisburg, PA 17120 l 717.214-2490 l Fax 717.346.6772

More information

ACHIEVE Human Services, Inc.

ACHIEVE Human Services, Inc. ACHIEVE Human Services, Inc. 3250-A East 40th Street, Yuma, AZ 85365 Phone: (928) 341-0335 Fax: (928) 341-9462 OUR MISSION STATEMENT: Empower the individuals that we serve to live their lives to their

More information

AN EQUAL OPPORTUNITY EMPLOYER ~ THROUGH AFFIRMATIVE ACTION

AN EQUAL OPPORTUNITY EMPLOYER ~ THROUGH AFFIRMATIVE ACTION APPLICATION FOR EMPLOYMENT ACTION FOR BRIDGEPORT COMMUNITY DEVELOPMENT 1070 PARK AVENUE, BRIDGEPORT, CT O6604 PLEASE PRINT 203 366-8241 =========================================================================================

More information

PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY APPLICATION PROCEDURES

PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY APPLICATION PROCEDURES PUBLIC HEALTH - DAYTON & MONTGOMERY COUNTY APPLICATION PROCEDURES 1. A completed Application for Employment and Consent to Procurement of Consumer Credit Report are mandatory. The Office of Human Resources

More information

Freshman/Transfer Student Profile FALL 2012 Office of Enrollment Management

Freshman/Transfer Student Profile FALL 2012 Office of Enrollment Management Freshman/Transfer Student Profile FALL 0 Office of Enrollment Management Dear Readers, I am pleased to share the East Stroudsburg University Fall 0 Freshman and Transfer Student Profile. With ongoing updates,

More information

DANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456

DANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456 APPLICATION FOR EMPLOYMENT DANVILLE-PITTSYLVANIA COMMUNITY SERVICES 245 HAIRSTON STREET DANVILLE, VIRGINIA 24540 434-799-0456 INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING THIS APPLICATION 1. The

More information

APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT APPLICATION FOR EMPLOYMENT Redwood Area Hospital is an Equal Opportunity Employer and does not discriminate in hiring or any other decisions on the basis of race, color, creed, religion, national origin,

More information

UPMC Health Plan For Individuals & Families

UPMC Health Plan For Individuals & Families UPMC Health Plan For Individuals & Families UPMC Health Plan knows how important it is to understand and choose the most affordable coverage for yourself and your family. You need to enroll in the plan

More information

P.O. Box 299 Saint Louis, Missouri 63166. Application for Employment

P.O. Box 299 Saint Louis, Missouri 63166. Application for Employment P.O. Box 299 Saint Louis, Missouri 63166 Application for Employment INSTRUCTIONS: 1. Please type or print legibly in INK. 2. Answer all questions. 3. Carefully read acknowledgment on last page. 4. Include

More information

Jackson State University

Jackson State University Jackson State University the gateway to excellence in graduate studies Graduate Application Application Guidelines and Information Admission is granted jointly by the Division of Graduate Studies and the

More information

GRADUATE APPLICATION PACKET

GRADUATE APPLICATION PACKET GRADUATE APPLICATION PACKET Graduate Degree and Certificate Programs Marymount offers a wide variety of graduate degree and certificate programs designed to support the career goals of professionals. BUSINESS

More information

Healthy PA PROMISe and EVS Changes Training. December 2014 January 2015 Provider Training

Healthy PA PROMISe and EVS Changes Training. December 2014 January 2015 Provider Training Healthy PA PROMISe and EVS Changes Training December 2014 January 2015 Provider Training Acronyms and Terms Term Clinical Validation Consumer Service Center Encouraging Employment Federally-Facilitated

More information

Boones Creek Animal Hospital PLEASE COMPLETE THE FOLLOWING INFORMATION:

Boones Creek Animal Hospital PLEASE COMPLETE THE FOLLOWING INFORMATION: Boones Creek Animal Hospital PLEASE COMPLETE THE FOLLOWING INFORMATION: Job Applied For: q Receptionist q RVT q Assistant q Other HOW DID YOU LEARN ABOUT THIS POSITION? q Newspaper (List Publication) q

More information

Frequently Asked Questions:

Frequently Asked Questions: All completed application may be returned in person or mailed to our office at 3000 Business Center Drive Alexandria, Virginia 22314. Incomplete applications will be returned. You must include a criminal

More information

EVIDENCE OF COVERAGE RESERVE (MSA) GEISINGER GOLD. Geisinger Gold Member Services 1-800-498-9731. H8468_14246_6 File & Use 9/3/14 M-151-596-F

EVIDENCE OF COVERAGE RESERVE (MSA) GEISINGER GOLD. Geisinger Gold Member Services 1-800-498-9731. H8468_14246_6 File & Use 9/3/14 M-151-596-F Geisinger Gold Member Services 1-800-498-9731 Toll-Free October 1 - February 14 8am - 8pm 7 days a Week February 15 - September 30 8am - 8pm Monday - Friday GEISINGER GOLD RESERVE (MSA) EVIDENCE OF COVERAGE

More information

Neillsville Care & Rehab

Neillsville Care & Rehab 216 Sunset Pl Phone: (715) 743-5444 Fax: (715) 743-5448 An Equal Opportunity, Affirmative Action Employer Employment Application Position Applying for: PLEASE PRINT IN INK PERSONAL DATA LAST NAME FIRST

More information

Graduate Admission Application

Graduate Admission Application For applicants seeking Master s/specialist Degree or Post-Baccalaureate/ Post-Master s Certificate Graduate Admission Application Office of Admissions Campus Box 1047 Edwardsville, IL 62026-1047 Phone:

More information

Speech-Language Pathologist Limited License Application Checklist

Speech-Language Pathologist Limited License Application Checklist Speech-Language Pathologist Limited License Application Checklist I. All Applicants Must Submit: $100.00 Fee (check or money order payable to the Board of SLP) A recent 2x2 passport size color photo Signed

More information

Application for Admission

Application for Admission Application for Admission LL.M. in International Legal Studies American University Washington College of Law INSTRUCTIONS If you have any questions please contact us at llm@wcl.american.edu before completing

More information

University of Illinois College of Veterinary Medicine Coordinated Degree Program Application Package Augustana College 2015

University of Illinois College of Veterinary Medicine Coordinated Degree Program Application Package Augustana College 2015 Augustana College and University of Illinois Coordinated Degree Program Baccalaureate of Arts/Doctorate of Veterinary Medicine (BA/DVM) (version 8/28/2015) Augustana College and the College of Veterinary

More information

BY: To be eligible to receive COMMCARE Waiver services, a consumer must meet all of the following criteria:

BY: To be eligible to receive COMMCARE Waiver services, a consumer must meet all of the following criteria: MEDICAL ASSISTANCE BULLETIN COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE NUMBER: 05-02-04, 17-02-05, 19-02-07, 23-02-02, 28-02-03, 29-02-05, 38-02-01, 39-02-01, 41-02-05, 43-02-01, 51-02-01,

More information