DOCTORATE DEGREE PROGRAMS

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1 DOCTORATE DEGREE PROGRAMS Application Fo Admission College Road, Lisle, Illinois Enollment Cente Phone: (630) Outside Illinois: (888) FAX: (630) Web Addess: ben.edu Application fee waive code ADM staff appoval Date

2 Docto of Philosophy (Ph.D.) in Oganization Development (O.D.) 1. Send all mateials fo the Lisle campus pogam to: Ph.D. in O.D. Pogam Coodinato College of Business, Benedictine Univesity, 5700 College Road, Lisle, IL A pesonal inteview with a doctoate faculty membe will be scheduled afte eceipt of all documents: Application fo admission and $50 application fee (non-efundable) Cuent esume (including petinent publications, pesentations and involvement in pofessional oganizations) Caee objective essay 3. Official tanscipts beaing the signatue of the egista and the institutional seal must be issued by diect mail fom the institution to Benedictine Univesity s Ph.D. in O.D. Pogam Coodinato. 4. Applications fo the Apil 2016 stat on the Lisle campus ae accepted beginning July 1, All documents submitted become popety of Benedictine Univesity and will not be eleased to the student o any thid paty. 6. Students with a documented physical o mental disability may be eligible fo special accommodations though the Ameicans with Disabilities Act. Please contact the Student Success Cente fo moe infomation. APPLICATION INFORMATION Docto of Education (Ed.D.) in Highe Education and Oganizational Change 1. Send all mateials to: Ed.D. Office Highe Education and Oganizational Change, Kindlon Hall, Benedictine Univesity, 5700 College Road, Lisle, IL A pesonal inteview with an Ed.D. faculty membe is equied afte eceipt of all documents. Application fo admission and $50 application fee (non-efundable) Cuent esume (including petinent publications, pesentations and involvement in pofessional oganizations) 3. Official tanscipts beaing the signatue of the egista and the institutional seal must be issued by diect mail fom the institution to Benedictine Univesity s Ed.D. Office. 4. Applications fo the August stat ae accepted though July All documents submitted become popety of Benedictine Univesity and will not be eleased to the student o any thid paty. 6. Students with a documented physical o mental disability may be eligible fo special accommodations though the Ameicans with Disabilities Act. Please contact the Student Success Cente fo moe infomation. Docto of Philosophy (Ph.D.)/Docto of Business Administation (D.B.A.) in Values-Diven Leadeship 1. Send all mateials to: Ph.D./D.B.A. Associate Diecto, Cente fo Values- Diven Leadeship College of Business, Benedictine Univesity, 5700 College Rd., Lisle, IL A pesonal inteview with a doctoate faculty membe may be scheduled afte eceipt of all documents: Completed application fo admission and $50 application fee (non-efundable) Pofessional esume (including employment histoy with details of leadeship esponsibilities, skill sets and esults; school, community and othe leadeship positions; sevice activities; petinent publications, pesentations and involvement in pofessional oganizations) Caee objective essay please see essay section fo details. 3. Official tanscipts beaing the signatue of the egista and the institutional seal must be issued by diect mail fom the institution to Benedictine Univesity s Ph.D./D.B.A. Associate Diecto. 4. Applications fo the Apil 2017 stat ae accepted beginning Apil 1, 2016; Deadline is Novembe 1, Applications eceived afte Novembe 1, 2016 will be consideed on a space-available basis. 5. All documents submitted become popety of Benedictine Univesity and will not be eleased to the student o any thid paty. 6. Students with a documented physical o mental disability may be eligible fo special accommodations though the Ameicans with Disabilities Act. Please contact the Student Success Cente fo moe infomation. GENERAL INFORMATION LAST NAME FIRST MIDDLE MOBILE PHONE OFFICE PHONE HOME PHONE OTHER NAMES MAIDEN (IF ANY) SOCIAL SECURITY NUMBER HOME COUNTRY STREET ADDRESS ADDRESS CITY STATE 9-DIGIT ZIP CODE RELIGION (OPTIONAL) COUNTY MARITAL STATUS MALE DATE OF BIRTH (MM/DD/YY) SINGLE MARRIED OTHER FEMALE Is English the pimay language spoken in the home? No Yes If no, please state language Ae you a U.S. citizen? No If yes, check one: By bith Yes By natualization (natualization cetificate numbe:) If no, ae you a U.S. pemanent esident/immigant/geen cad holde? No Yes If yes, please attach a copy of you pemanent esidency cad. Have you eve pleaded guilty o no contest to, o been convicted of, a felony? No Yes If yes, please povide date(s) and details ANSWERING YES DOES NOT CONSTITUTE AN AUTOMATIC BAR TO ADMISSION. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT. NOTE: YOU ARE NOT OBLIGATED TO DISCLOSE THE EXISTENCE OF ANY CONVICTION OR ARREST RECORDS WHICH HAVE BEEN SEALED OR EXPUNGED PURSUANT TO CHAPTER 20, SECTION 2630/12 OF THE ILLINOIS COMPILED STATUTES.

3 EDUCATIONAL HISTORY NAME OF HIGH SCHOOL MONTH/YEAR OF HIGH SCHOOL GRADUATION OR GED IMPORTANT: FAILURE TO LIST BELOW ALL SECONDARY SCHOOLS, UNIVERSITIES AND POST-SECONDARY INSTITUTIONS IN WHICH YOU ENROLLED (INCLUDING CORRESPONDENCE AND EXTENSION COURSES) MAY RESULT IN DELAY IN ADMISSION, LOSS OF TRANSFER CREDIT, AND/OR DISMISSAL. IT IS THE APPLICANT S RESPONSIBILITY TO HAVE OFFICIAL TRANSCRIPTS FORWARDED FROM EACH INSTITUTION IN WHICH YOU ENROLLED. AN OFFICIAL TRANSCRIPT IS REQUIRED EVEN IF ENROLLMENT WAS FOR A BRIEF TIME AND NO CREDIT WAS ESTABLISHED. NAME(S) OF ALL COLLEGE(S) ENROLLED AND CITY/STATE DATES ENROLLED DEGREE CONFERRED MAJOR MINOR GPA (Undegaduate & Gaduate Level) (check box if last school attended) Fo students with intenational postgaduate level cedits,* indicate yeas of full-time study instead of cedit hous: One yea o less Two yeas Thee yeas Fou yeas o moe *Students with cedits eaned outside the United States may be equied to have these cedits evaluated. Will you have a postgaduate degee completed pio to enollment at Benedictine Univesity? No Yes If yes, what degee? I undestand that I must disclose all schools enolled and failue to do so can lead to the denial of admission, evoking of admission o administative withdawal fom couse enollment. Signatue Have you eve applied to any doctoate pogam at Benedictine Univesity? No Yes If yes, when? Have you eve enolled at Benedictine Univesity? No Yes If yes, dates enolled If yes, have you attempted any college cedit since attending Benedictine Univesity? No Yes Have you eve been suspended, placed on pobation o dismissed fom any high school o college? No Yes If yes, please explain the following on a sepaate sheet of pape: date of occuence, summay of incident, how you wee held accountable (outcomes, sanctions, etc.) and any additional infomation you wish to povide. Please note: additional infomation may be equested. ACADEMIC INFORMATION PLEASE CHOOSE THE PROGRAM FOR WHICH YOU ARE APPLYING Docto of Education in Highe Education and Oganizational Change Docto of Philosophy in Oganization Development Docto of Philosophy/Docto of Business Administation in Values-Diven Leadeship ADMISSIONS INFORMATION When do you expect to ente Benedictine Univesity? On what campus do you plan to attend? Lisle/Napeville Spingfield Othe How did you hea about Benedictine Univesity? Have you visited the Benedictine Univesity campus yet? No Yes LETTERS OF REFERENCE PLEASE ATTACH All doctoate pogams equie two lettes of efeence. Fo the Ph.D./D.B.A. and Ph.D. in O.D. pogams, submit two lettes of ecommendation, one pofessional and one academic that speak to you chaacte, capacity, pefomance and ability to do doctoal level wok with excellence. Please list the name, elationship and position of efeences below: NAME RELATIONSHIP POSITION NAME RELATIONSHIP POSITION

4 ENTRANCE REQUIREMENTS Ph.D. in Oganization Development Maste s degee fom an accedited institution. Fo intenational students, Test of English as a Foeign Language (TOEFL)/Intenational English Language Testing System (IELTS) of 550 (pape-based), o 79 (Intenet-based) and 6.0 IELTS. Date Taken PAPER-BASED TEST Scoe INTERNET-BASED TEST Ph.D./D.B.A. in Values-Diven Leadeship Maste s degee fom an accedited institution. Fo intenational students, Test of English as a Foeign Language (TOEFL)/Intenational English Language Testing System (IELTS) of 550 (pape-based), o 79 (Intenet-based) and 6.0 IELTS. Date Taken PAPER-BASED TEST Scoe INTERNET-BASED TEST Ed.D. in Highe Education and Oganizational Change Maste s degee fom an accedited institution. Minimum GPA of 3.00 on 4.00 scale in most ecent maste s degee and in the last 30 hous of gaduate cedit if post-maste s. A witing sample, pefeably academic, fom ecent gaduate wok, employment o pofessional activity. Thee yeas of full-time employment o equivalent. Fo intenational students, Test of English as a Foeign Language (TOEFL)/Intenational English Language Testing System (IELTS) of 550 (pape-based), o 79 (Intenet-based) and 6.0 IELTS. Date Taken PAPER-BASED TEST Scoe INTERNET-BASED TEST ESSAY STATEMENT PLEASE ATTACH WITH MOST CURRENT RESUME Ph.D. in Oganization Development Please type you esponse to the following, double-spaced, one-to-five pages in length: Descibe how the Ph.D. fits with you long-tem caee objectives. Please include potential aeas of eseach inteest and any intenational wok expeience. Ed.D. in Highe Education and Oganizational Change Please submit an essay/statement explaining you caee and pofessional goals. Descibe you eadiness fo doctoal wok and eseach inteests, and identify what you expect to gain fom you doctoal studies and how they will enable you to achieve you goals. Ae you cuently employed? No Yes Full Time Pat Time Ae you a vetean o cuently seving in the U.S. Militay? No Yes EMPLOYER INFORMATION Ae you o have you eve been an employee of Benedictine Univesity? No Yes Ph.D./D.B.A. in Values-Diven Leadeship 1. Descibe you pesonal and pofessional goals and how a Ph.D./ D.B.A. will help you achieve you goals. 2. Descibe why you ae inteested in a degee in Values-Diven Leadeship. 3. Descibe potential topics of inteest fo you dissetation. 4. Doctoate pogams ae igoous but ewading. Please comment on pesonal attibutes as well as pevious expeiences that ae eflective of you ability to successfully complete a doctoate-level pogam. You ae encouaged to be ceative in you answe but hee ae some suggestions of infomation you may want to conside when cafting you esponse: Pevious academic and pofessional expeiences that document you capacity fo leaning Pesonal chaacteistics you will contibute to the pogam What makes you a good candidate fo this pogam EMPLOYER/COMPANY NAME POSITION TELEPHONE WORK (OPTIONAL) ADDRESS CITY, STATE, ZIP COUNTY COUNTRY DESCRIBE YOUR CURRENT JOB RESPONSIBILITIES

5 INTERNATIONAL STUDENT INFORMATION If you ae an intenational applicant fo a doctoal pogam planning to study unde a visa, please complete the following infomation showing equied citizenship and financial infomation. An intenational applicant is a citizen o pemanent esident alien of a county othe than that of United States. Any student who is a U.S. citizen o a U.S. pemanent esident with intenational cedit is consideed a domestic student and does not need to complete this page. County of citizenship: County of bith: City of bith: County of esidency: Ae you cuently in the U.S. on a visa? No Yes If yes to above, please indicate visa type: When does you cuent visa expie? Month: Day: Yea: Please indicate which school in the U.S. you ae attending: If you intend to tansfe you SEVIS ecod fom you cuent school, please fo citical infomation. Please send copies of the following documents: You cuent visa All I-20s and/o DS-2019s You cuent I-94* (font and back) I-94s, passpot photocopies and visas of all dependents *Electonic I-94s may be pinted fom I equest Benedictine to issue the following: I-20 (fo F-1 student visa). My pimay souce of funding will be a Benedictine assistantship, pesonal funds o funds fom family o fiends. (F-1 dependents will be issued F-2 visas.) DS-2019 (fo J-1 Exchange Visito/Student visa). My pimay souce of funding will be U.S. o home-county govenment o an intenational oganization. (J-1 dependents will be issued J-2 visas.) I do not need Benedictine documents because my sponsoing agency will issue (e.g. Fulbight). I will emain on visa (attach photocopies of you visa and I-94). INTERNATIONAL STUDENT FINANCIAL SUPPORT FORM (fo F and J visa students only) Please complete all infomation equested in this section. I. Souce of Suppot I will pay fo school with my pesonal funds. I will be sponsoed by anothe individual, i.e. paents, family membe, othe sponso. I will be sponsoed by a govenment o oganization. Official documents in the fom of bank statements, cetified scholaships o awad lettes must be eceived and will not be etuned. II. Souce of Funds (Amounts in this section must match attached financial documents): Name of Account Holde: Name of Financial Institution: Addess of Institution: Name of Institution Official: Account Numbe: Sponsoing Oganization: Total Amount Available in USD: $ III. Student Declaation of Accuacy I cetify that the infomation given on this fom is complete and accuate to the best of my knowledge. I am fully awae that any false o misleading infomation will esult in disciplinay action and possible temination of my SEVIS ecod. Name Signatue Date

6 READ CAREFULLY AND SIGN AS INDICATED REQUIRED I AGREE TO COMPLY WITH THE REGULATIONS AND REQUIREMENTS OF BENEDICTINE UNIVERSITY, AND TO COOPERATE WITH THE ADMINISTRATIVE OFFICERS, FACULTY AND MY FELLOW STUDENTS IN MAINTAINING HIGH STANDARDS OF CONDUCT AND SCHOLARSHIP AND IN PROMOTING THE GENERAL WELFARE OF THE UNIVERSITY. I UNDERSTAND THAT THE UNIVERSITY RESERVES THE RIGHT TO CANCEL THE REGISTRATION OF ANY STUDENT AT ANY TIME WHATSOEVER FOR REASON OF DEFICIENCY IN SCHOLARSHIP, UNSATISFACTORY CONDUCT OR FOR ANY OTHER JUST CAUSE. I AGREE TO PAY ALL FEES IN ADVANCE EACH TERM OR BY SPECIAL ARRANGEMENT WITH THE UNIVERSITY. I CERTIFY THAT THE INFORMATION I HAVE PROVIDED IS TO THE BEST OF MY KNOWLEDGE CORRECT AND COMPLETE. FAILURE TO PRESENT ACCURATE INFORMATION IN THIS DOCUMENT CAN LEAD TO THE DENIAL OF ADMISSION, REVOKING OF ADMISSION OR ADMINISTRATIVE WITHDRAWAL FROM COURSE ENROLLMENT. I HEREBY AUTHORIZE BENEDICTINE TO INVESTIGATE ANY STATEMENT CONTAINED IN THIS APPLICATION. I HEREBY RELEASE ANY PARTY FROM LIABILITY AS A RESULT OF ANY INFORMATION PROVIDED TO BENEDICTINE. IT IS UNDERSTOOD THAT I ACCEPT REGISTRATION AS A STUDENT AT BENEDICTINE SUBJECT TO THE ABOVE PROVISIONS. I UNDERSTAND THAT I MAY BE PHOTOGRAPHED OR VIDEOTAPED WHILE AT BENEDICTINE UNIVERSITY. I GIVE PERMISSION FOR PHOTOS OR VIDEOTAPE OF ME TO BE USED TO PROMOTE BENEDICTINE UNIVERSITY AND THAT SUCH PHOTOS AND VIDEO WILL BE THE PROPERTY OF BENEDICTINE UNIVERSITY. I ALSO GIVE PERMISSION FOR INFORMATION ABOUT MY ACCOMPLISHMENTS WHILE A STUDENT AT BENEDICTINE UNIVERSITY TO BE USED TO PROMOTE BENEDICTINE UNIVERSITY. Signatue of Applicant Date Fo additional infomation, please contact: Ph.D. in Oganization Development in Lisle Phyllis Meyes (630) Ed.D. in Highe Education and Oganizational Change Venon McCoy (630) Ph.D./D.B.A. in Values- Diven Leadeship Kenda Adeszko (630)

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