Graduate Application Form

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1 Graduate Application Form Apply Applicant Name Former Name Social Security Number Graduate Admissions Office Central Connecticut State University 1615 Stanley Street P.O. Box 4010 New Britain, CT CHECK LIST FOR ADMISSIONS IMPORTANT NOTES: PLEASE CHECK YOUR APPLICATION FOR GRADUATE ADMISSION TO ENSURE COMPLETENESS AND ACCURACY. Errors or omissions will delay the processing of your file. Please be sure to: 1. Have OFFICIAL TRANSCRIPTS FOR EACH COURSE FORWARDED DIRECTLY to the Graduate Admissions Office by each previously attended college or university. Do not hand carry transcripts. 2. Provide your Social Security Number. 3. Sign and date the back page of the application. 4. Submit the $50.00 processing fee (non-refundable). 5. Specify complete address and telephone number. 6. Contact your academic department for information about specific program and admissions requirements. (See list of programs on pages 4 and 5.) 7. Submit to your academic department any additional materials required (e.g., departmental packet, essay). See additional materials list at 8. Green card holders: Please send a photocopy of the front and back of your green card or proof of eligible non-citizenship. For office use only: Information Requested Date For office use only: Fee CPA Degree Program Specialization Advisor Action/Date

2 GRADUATE APPLICATION FORM ADMISSION Requested for: (year) Session: Fall Spring Summer (limited program availabilty) Full time Part time Will you request admission under the New England Regional Program: Yes No If you are part of a cohort, please indicate location: (CITY/TOWN) NAME SOCIAL SECURITY NUMBER PLEASE INDICATE ANY FORMER NAMES (Last and first name if applicable) LEGAL ADDRESS (NO.) (STREET) (CITY/TOWN) (STATE OR COUNTRY) (POSTAL CODE) MAILING ADDRESS (NO.) (STREET) (CITY/TOWN) (STATE OR COUNTRY) (POSTAL CODE) ADDRESS HOME PHONE NUMBER WORK PHONE NUMBER ( ) ( ) DATE OF BIRTH (M/D/Y) ARE YOU A U.S. CITIZEN? Yes No YEARS IN USA YEARS IN CONNECTICUT ARE YOU A "LEGAL RESIDENT" OF CONNECTICUT? Yes No (See page 5) ARE YOU A VETERAN? Yes No If Yes, Discharge Date: LENGTH OF SERVICE SELECTIVE SERVICE NUMBER IF YOU ARE NOT A U.S. CITIZEN, PLEASE COMPLETE THIS SECTION: COUNTRY OF CITIZENSHIP ARE YOU IN THE U.S. NOW? Yes No IF YES, VISA TYPE: STUDENT VISA SOUGHT Yes No GREEN CARD # HAVE YOU PREVIOUSLY APPLIED FOR GRADUATE STUDY AT CCSU? YES NO IF YES, WHAT YEAR? WERE YOU OFFICIALLY ADMITTED TO A GRADUATE PROGRAM? YES NO HAVE YOU PREVIOUSLY TAKEN COURSES AT CCSU? YES NO IF YES, WHAT YEAR(S)? DID YOU ATTEND CCSU AS: A GRADUATE STUDENT AN UNDERGRADUATE STUDENT

3 GRADUATE APPLICATION FORM ADVANCED DEGREES COMPLETED PRIOR TO APPLICATION: BACHELOR S DEGREE MASTER S DEGREE SIXTH-YEAR DIPLOMA FIRST PROFESSIONAL DEGREE (MBA, MD, DDM, JD) Ph.D./ Ed.D. List below in order (present or most recent first) all educational institutions where you have taken any course or attended beyond high school (including Central Connecticut State University). You must request that each institution send an official transcript directly to Graduate Admissions. Failure to list all institutions and provide an official transcript directly from each institution may be cause for dismissal or nonadmission. You do not need to request official transcripts from Central Connecticut State University. INSTITUTION NAME LOCATION DATES ATTENDED DEGREE AWARDED MAJOR (City/State/Country) From-To (M/Y): (M/Y): ADDITIONAL INFORMATION: IF REQUIRED, HAVE YOU TAKEN: TOEFL YES NO DATE SCORE GRE YES NO DATE SCORE DO YOU HOLD A TEACHER CERTIFICATE FROM CONNECTICUT OR ANY OTHER STATE? YES NO CONNECTICUT CERTIFICATE TYPE: IS YOUR CERTIFICATE CURRENT? YES NO INITIAL ENDORSEMENT AREAS: PROVISIONAL PROFESSIONAL PLACE OF EMPLOYMENT DATES OF EMPLOYMENT CITY, STATE (most recent first) HONORS/RECOGNITION

4 LIST OF GRADUATE PROGRAMS (Please check only one program for which you are an applicant) DOCTORAL PROGRAM Ed.D. EDUCATIONAL LEADERSHIP* (fall, odd years only) SIXTH-YEAR CERTIFICATE EDUCATIONAL LEADERSHIP* (summer/fall only) READING & LANGUAGE ARTS CONSULTANT* MASTER OF ARTS IN TEACHING** MAT: Teacher Education (Spring, Summer) English* Mathematics* Sciences* Spanish* Technology & Engineering Education* MASTER OF ARTS BIOLOGICAL SCIENCES Ecology & Environmental Sciences* General * ENGLISH* HISTORY* INFORMATION DESIGN* MATHEMATICS Actuarial Mathematics Computer Science General Statistics MODERN LANGUAGE Hispano North American Inter University: Spanish Language & Hispanic Cultures (summer availability) Italian Spanish PSYCHOLOGY Community Psychology* General Psychology* Health Psychology* PUBLIC HISTORY* BIOMOLECULAR SCIENCES* MASTER OF SCIENCE ANESTHESIA* (summer availability) BIOLOGICAL SCIENCES General* Health Science* COMMUNICATION* CRIMINAL JUSTICE* DATA MINING* (online program) GEOGRAPHY INTERNATIONAL STUDIES NATURAL SCIENCES Earth Science Physics Science Education School of Education & Professional Studies COUNSELOR EDUCATION (fall only) Professional Counseling* School Counseling* Student Development in Higher Education* EARLY CHILDHOOD EDUCATION EDUCATIONAL FOUNDATIONS Educational Foundation Policy Secondary Education* EDUCATIONAL LEADERSHIP EDUCATIONAL TECHNOLOGY ELEMENTARY EDUCATION* MARRIAGE & FAMILY THERAPY PHYSICAL EDUCATION READING & LANGUAGE ARTS* SPECIAL EDUCATION* For teachers not seeking cross-endorsement in Special Education (A) For teachers seeking cross-endorsement in Special Education (B) For teachers certified in Special Education (C) CONSTRUCTION MANAGEMENT TECHNOLOGY MANAGEMENT ENGINEERING TECHNOLOGY Civil/Construction Mechanical/Manufacturing The following MS programs are offered in collaboration with the School of Education & Professional Studies to meet accreditation standards. ART EDUCATION* MATHEMATICS For Certified Elementary Teachers For Certified Secondary Teachers MUSIC EDUCATION* (summer availability) SPANISH* TESOL* School of Business BUSINESS EDUCATION* TECHNOLOGY & ENGINEERING EDUCATION **MAT degree program leads both to a master s degree and initial teacher certification. Unless noted, all programs have fall/spring application dates.

5 LIST OF GRADUATE PROGRAMS (Please check only one program for which you are an applicant) Schools of Arts and Sciences, Business, and Engineering & Technology (Interdisciplinary Program) COMPUTER INFORMATION TECHNOLOGY* Computer Science Networking and Telecommunications Technology POST MASTERS ART EDUCATION* ENGLISH HISTORY MUSIC EDUCATION* NATURAL SCIENCES COUNSELOR EDUCATION School Counseling* Student Development and Higher Education* EARLY CHILDHOOD EDUCATION ELEMENTARY EDUCATION* PHYSICAL EDUCATION OFFICIAL NON-DEGREE CERTIFICATE PROGRAMS DATA MINING* PUBLIC RELATIONS & PROMOTIONS CELL & MOLECULAR BIOLOGY* CONSTRUCTION MANAGEMENT ENVIRONMENTAL HEALTH & SAFETY LEAN MANUFACTURING & SIX SIGMA SUPPLY CHAIN MANAGEMENT/ LOGISTICS and Engineering & Technology PRE-HEALTH STUDIES* TEACHER CERTIFICATION School of Education & Professional Studies ELEMENTARY EDUCATION NK 12 EDUCATION ART* MUSIC* PHYSICAL EDUCATION SPECIAL EDUCATION TECHNOLOGY & ENGINEERING EDUCATION TESOL* SECONDARY EDUCATION BIOLOGY BUSINESS ENGLISH FRENCH GERMAN HISTORY ITALIAN MATHEMATICS SCIENCE EDUCATION Chemistry Earth Science General Science Physics SOCIAL STUDIES GLOBAL LEADERSHIP & LITERACY SPANISH READING & LANGUAGE ARTS* SUPERINTENDENT OF SCHOOLS *Programs require submission of additional materials. See for a complete listing of additional requirements.

6 GRADUATE APPLICATION FORM LEGAL RESIDENT CLASSIFICATION FOR TUITION PURPOSES According to PA of the Connecticut General Statutes, the following shall determine in-state student status for tuition purposes: 1. Establishment of a new domicile or legal residency in the State of Connecticut for at least a preceding one-year period constitutes domicile. 2. Marriage to a Connecticut permanent resident holding a green card (for at least a preceding one year period) or U.S. citizen constitutes domicile. 3. Service in the armed forces of the U.S. by Connecticut residents does not affect state domicile. 4. Upon moving to Connecticut, obtaining full-time employment, and providing evidence of domicile (not for full-time education purposes) for twelve consecutive prior months, an individual and family members may apply for in-state residency. NOTE: Attendance at a Connecticut institution of higher education does not constitute residency when a student s home is in another state or country or domicile of a dependent student is with his/her parents. The University may require materials be provided as proof of Connecticut residency. Until such time as a determination can be made, the applicant will be otherwise classified. (To download Residency Affidavit: Non-citizens studying at the University cannot become residents for purposes of tuition payment unless granted approval for a Permanent Resident Visa by the United States Government one year prior to the date of admission application. Students granted such visas might make application for classification as an in-state student when they have satisfied the necessary statutory requirements for legal residence. The following information is requested for statistical purposes and is optional. GENDER: Male Female RACE: African-American Hispanic or Latino (non Puerto Rican) Other Asian or Pacific Islander Native American Prefer not to respond Caucasian Puerto Rican HOW DID YOU HEAR ABOUT CCSU? Newspapers CCSU Website graduateguide.com Other Radio Graduate School Guide Friend graduateschool.com Peterson s By signing this application for admission, I agree to comply in good faith with all University policies and regulations. Further, I understand that any misleading information I have provided on this form may be cause for my non-admission or dismissal from the graduate program. Applicant s Signature: Date: Official Admission is granted only by a letter of acceptance from the Graduate Admissions Office. No application is considered complete until all transcripts and supporting documents have been received. Contact the Graduate Admission Office at concerning questions on application and admission deadlines. THIS APPLICATION FORM, THE $50.00 NON-REFUNDABLE PROCESSING FEE (check or money order payable to CCSU), AND ALL REQUIRED CREDENTIALS SHOULD BE MAILED TO: GRADUATE RECRUITMENT & ADMISSIONS OFFICE CENTRAL CONNECTICUT STATE UNIVERSITY 1615 STANLEY STREET P.O. BOX 4010 NEW BRITAIN, CT

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