APPLICATION. for Graduate & Credential Admission POINT LOMA NAZARENE UNIVERSITY

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1 APPLICATION for Graduate & Credential Admission POINT LOMA NAZARENE UNIVERSITY

2 About Point Loma Nazarene University The university, established in 1902 by the Church of the Nazarene, offers quality liberal arts and professional programs on its Point Loma campus and select graduate and professional programs throughout the denomination s southwest educational region. Mission Statement Point Loma Nazarene University exists to provide higher education in a vital Christian community where minds are engaged and challenged, character is modeled and formed, and service becomes an expression of faith. Being of Wesleyan heritage, we aspire to be a learning community where grace is foundational, truth is pursued, and holiness is a way of life. Nature of the Program As a Christian institution, Point Loma Nazarene University seeks candidates who appreciate and respect the university s mission in their personal and professional lives. Both on and off campus, we expect our graduate and credential students to represent Point Loma appropriately and ethically. By signing and submitting this application, you are agreeing to do so. Notice of Nondiscrimination In accordance with Title VI of the Civil Rights Act of 1964, Point Loma Nazarene University does not discriminate on the basis of race, color, age, or national origin. Furthermore, as required by Title IX of the 1972 Education Amendments, Point Loma Nazarene University does not discriminate on the basis of sex in its educational programs, activities, or employment policies. Point Loma Nazarene University also provides equal opportunity for qualified handicapped persons in compliance with the requirements of Section 504 of the Rehabilitation Act of 1973, and the American Disabilities Act of The associate dean of students and academic advising provide advice and support to students with disabilities. Inquiries and appeals regarding compliance with these federal requirements should be directed to the vice president for student development. How to Apply Please send application and supporting materials to: Point Loma Nazarene University Mission Valley Regional Center Attn: Office of Graduate Admission 4007 Camino Del Rio South, Suite 101 San Diego, CA Fax: (619) Please enclose application fee with materials. Application Fee: $50 For Information Regarding Your Application: Call Toll-Free: (866) 692-GRAD THANK YOU FOR APPLYING TO POINT LOMA NAZARENE UNIVERSITY!

3 Application for Graduate & Credential Admission Please Print B. Personal Data (Please print in black ink and fill in all spaces completely.) Mr. Mrs. Ms. Rev. Dr. Other Name Previous or Additional Names Address Last First Middle Name Street (Apartment, Box, C/O) City State Zip Country (If not USA) Home Phone ( ) Cell Phone ( ) Date of Birth (MM/DD/YY) City and State of Birth Address Country of Birth (If not USA) Citizenship Status: US Citizen Permanent US Resident Non-Resident Country of Citizenship (If not USA) C. Statistical Information (Items in this section are for statistical purposes only. Answers will have no effect on admission decisions.) Marital Status: Single Married Gender: Male Female Church Affiliation or Denomination Home Church Name Ethnic Status: o Do you consider yourself to be of Hispanic or Latino descent? oyes ono Please select one or more categories that best describe your race: o American Indian or Alaska Native o Native Hawaiian or Other Pacific Islander o Asian o Black or African American o White or Caucasian D. Educational Aims at Point Loma Nazarene University (check all that apply) BIOLOGY MAJORS AND CONCENTRATIONS Master of Arts in Biology Master of Science in Biology EDUCATION MAJORS AND CONCENTRATIONS Master of Arts in Teaching Multiple Subject Single Subject Special Education Mild/Moderate Special Education Moderate/Severe Services Credential Preliminary Administrative Credential Only Clear Professional Administrative Credential PPS Credential Only Master of Arts in Education Counseling and Guidance Counseling and Guidance/PPS Credential Child Welfare & Attendance Educational Leadership Educ Leadership/Preliminary Admin Serv Cred Teaching & Learning Teach & Learning/Reading Certificate Teach & Learn / Clear Credential Master of Arts in Special Education Special Education: Autism Added Authorization Special Education: Emotional/Behavior Disorders Added Authorization Special Education: Early Childhood Added Authorization Special Education: Traumatic Brain Injury Added Authorization Special Education: Other Health Impaired Added Authorization A. MBA MAJORS AND CONCENTRATIONS Master of Business Administration (General) Healthcare Not for Profit Organizational Leadership Sustainability NURSING MAJORS AND CONCENTRATIONS BSN to Master of Science in Nursing ADN to Master of Science in Nursing Post MSN: Clinical Nurse Specialist Post MSN: Nurse Educator Family Health Nursing Medical-Surgical Nursing Mental Health Nursing Gerontological Nursing Clinical Nurse Specialist Nurse Educator SOCIAL SECURITY NUMBER MANDATORY MINISTRY MAJORS AND CONCENTRATIONS Master of Ministry OTHER PROGRAM NOT LISTED HERE: Name PLNU ID# Applfee Last First Middle Name Which PLNU regional center will you attend? San Diego (Point Loma or Mission Valley) Bakersfield Inland Empire District Partnership Other not listed:

4 E. Application Information I plan to enter: Year Fall Spring Summer Quad Anticipated Start Date I plan to be: Full time Part time (FT=6 or more graduate units/12 or more credential units) Have you ever previously applied to or attended PLNU? No Yes Year Applied Last Date of Attendance F. Academic Preparation (Must be filled in completely.) Have you earned a bachelor s degree? No Yes Graduation Date Major/Emphasis Undergraduate Grade Point Average (estimated if not complete) Have you completed any credential, license, or certificate programs? No Yes If yes, please list: Academic History List in chronological order the names of all colleges or universities attended (including PLNU if applicable) with dates of attendance and degrees earned, if any. Please avoid over abbreviating school names to ensure accuracy (i.e., CSU Los Angeles instead of CSULA). Name Location Date Attended (Start-End) Degree Earned Date Transcripts Requested G. Professional Experience Current Employer Occupational Field Position Work Address Work Phone ( ) Dates Employed Have you ever served in the military? No Yes Branch of Service Military Awards or Honors Street City State Zip Country (If not USA) Work History Please list additional work history below in chronological order. A resume may be submitted in lieu of completing this section. Name Location Date Employed (Start-End) Business Phone Position ( ) ( ) ( ) ( )

5 H. Additional Data How did you first learn about the graduate or credential programs offered at PLNU? Please list all sources through which you have heard of PLNU. Rank numerically, 1 as the highest, the three people, publications, or events that most influenced your decision to apply to PLNU. PLNU Student PLNU Family Member Open House Advertisement PLNU Alumnus Friend PLNU Publication PLNU Faculty Other (Please explain) Please list any relatives who have attended or worked at Point Loma Nazarene University: Name Date Attended (Employed) Relationship I. Certification of Accuracy and Understanding By signing below, I certify that the information on this application is true to the best of my knowledge. I have read all of the instructions, and I understand refusal of admission or cancellation of registration will result from misrepresentation in any portion of this application form. I further understand that any submitted records and documents may not be photocopied and are nonreturnable. By signing, I also agree to comply with Point Loma Nazarene University standards. Applicant s Signature Date REV 07/08

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