California State University, Bakersfield REGIONAL AND ONLINE DEGREE PROGRAMS 9001 Stockdale Highway 30BDC Bakersfield, California 93311-1022 Phone 661.654.6271 Fax 661.654.2447 www.csub.edu/regional MASTERS OF ARTS IN EDUCATION - CURRICULUM & INSTRUCTION (C&I) REGIONAL AND ONLINE DEGREE PROGRAMS APPLICANT CHECKLIST Directions to Applicant: Before mailing your application, please read and check the following points: Fill out application form completely Transcripts: One official transcript showing all undergraduate and graduate coursework from each institution attended must be submitted with your application. We would suggest you have all transcripts sent to yourself and submit unopened copies along with your application in one packet. Application/Evaluation Fee: If you are applying to a degree or credential program, submit a non-refundable Application Fee of $75.00 with this application payable to California State University, Bakersfield. Two C&I Graduate Reference Forms Reference forms must be submitted in a sealed envelope with the signature of the referee on the back flap. Copy of Valid Teaching Credential Completed C&I Technology Survey Basic Statistics course completed with a C or better Verification of Passage of the Graduate Writing Assessment Requirement (GWAR) The GWAR can be satisfied by the following options: http://www.csub.edu/testing/gwar.shtml) Statement of Purpose Applicants can use the page provided in the application or can attach a type written statement. CSU, Bakersfield requires that all students have immunization records on file verifying proof of MMR (Measles, Mumps, Rubella) vaccination. Please provide a copy of your MMR vaccination with your application or contact the Health Center (661.654.2394) to discuss your options to meet this requirement. This requirement will not prevent you from being admitted, but it will block you from registering for courses. Submit all application materials to: CSUB Regional and Online Degree Programs 9001 Stockdale Highway 30BDC Bakersfield, CA 93311-1022 ATTN: Regional Programs Evaluator Admission to the Regional degree program does not constitute admission to the CSUB Main Campus degree program. Students planning to attend classes on the Main CSUB campus should contact the Regional Programs Evaluator for more information. If you have any questions regarding this application, need information concerning the program or program criteria, please feel free to contact us at 661.654.6271. NONDISCRIMINATION POLICY EUD does not discriminate on the basis of race, color, national origin, sex, physical handicap, or sexual orientation in the educational programs or activities it conducts. Students admitted with physical, perceptual or learning disabilities will be given necessary accommodations provided that their disability has been verified by the CSUB Office of Services for students with Disabilities (661.654.3360).
PART A1 This is an application for: Fall Winter Spring Summer FOR OFFICE USE ONLY CHECK/M.O. #: AMOUNT: DATE RECEIVED: Specify major/program objective: Option, emphasis or concentration (if any): Legal name: Last First Middle Other name(s) that may appear on your academic records: Last First Middle Last First Middle Birthdate: Sex: Male Female Social Security Number: CSUB ID# (if applicable): Current mailing address: Permanent address if different from current address: Phone Number: Fax Number: Alt. Phone Number: Email: FOR OFFICE USE ONLY TRANSCRIPTS GWAR REFERENCES SURVEY CREDENTIAL OVERALL GPA: LAST 90 GPA: DEGREE: STATS: ACCEPTED DENIED
Country of Citizenship (all must answer): Use the options listed below to provide your citizenship code: Y US Citizen R Refugee/Asylum F F Visa (student) J J Visa N None of the above I Immigrant I-551 ( green card ) Date issued: (be prepared to submit verification) PART A2 O Other visa (specify): Date issued: If you were born outside the US, what year did you move to the US? Use the options listed below to provide your ethnic identity code: 1 American Indian or Alaskan Native; tribe: 2 Black, non-hispanic, including African American 3 Mexican American, Mexican, Chicano 4 Other Latino, Spanish- origin, Hispanic 5 Other Asian 6 Other Pacific Islander 7 White 8 Other 9 No Response A Central American B South American C Chinese D Decline to State F Filipino G Guamanian H Hawaiian J Japanese K Korean L Laotian M Cambodian N Samoan P Puerto Rican Q Cuban R Asian Indian S Other Southeast Asian T Thai V Vietnamese The application form provides you with an opportunity to report your primary racial or ethnic identity. However, you may use the web to provide the CSU with more complete information regarding your racial/ethnic identity, if you wish. Neither you nor others can view any data collected on the website. Any information you submit on the website will override and updated any existing information. The address for the website is http://csuethnicsurvey.xap.com. List your California County of residence, other US State or Country: Are you a Veteran? Yes No Print the names and locations of all colleges and universities attended, even if no coursework was completed. Begin with the last institution attended. Attach a separate sheet if you need more space. Enrolled: Degree Awarded: School Name State From To AA/AS/BA/BS/etc. Are you eligible to re-enroll at all institutions previously attended? Yes No (if not, please attach explanation)
PART A3 CERTIFICATION to be read and signed by all applicants to certify the accuracy of the information provided. I certify under penalty of perjury under the laws of the State of California and the United States that I have provided complete and accurate responses to the items on this application. I further certify that all official documents submitted in support of this application are authentic and unaltered records that pertain to me. I authorize the California Sate University to release any information submitted by me in connection with my application to any person, firm, corporation, association, or government agency to verify or explain the information I have provided, to obtain other records necessary for my application, or in connection with perjury proceedings. My signature certifies the accuracy and completeness of the information provided. I understand that any misrepresentation may be cause for denial or cancellation of admission or enrollment. I certify that so long as I am a student at this institution, I will advise the residence clerk if there is a change in any of the fact affecting my residence. City and County Applicant s Signature Date When claiming California residency and completing this form outside of California, it must be subscribed and sworn to before a person authorized to administer oaths, such as a notary public. You are required to include your social security number (or taxpayer identification number) on admission application forms to all CSU campuses pursuant to Section 41201, Title 5, Code of California Regulations and Section 6109 of the Internal Revenue Code. CSU campuses use the social security number to identify your student records maintained in your association with the campus and, if needed, to help collect debts owed the university. Your social security number may be written on your application fee check to facilitate the processing of your fee payment. Also, the Internal Revenue Service requires the university to file information returns that include the student s social security number and other information such as the amount paid for qualified tuition, related expenses, and interest on educational loans. That information is used to help determine whether you, or a person claiming you as a dependent, may take a credit or deduction to reduce federal income taxes. If you do not have a social security number at the time you file the application, you may leave the item blank and the campus will assign a temporary number. However, you are required to obtain a social security number and submit it to the university by the time you begin enrollment. Failure to furnish your correct social security number may result in the imposition of a penalty by the Internal Revenue Service.
PART B1 Completion of Part B is required; it will be forwarded to the department responsible for the degree or credential sought. The information provided below should support the information provided on PART A. This is an application for: Fall Winter Spring Summer Specify major/program objective: Social Security Number: CSUB ID# (if applicable): Legal name: Last First Middle Current mailing address: Phone Number: Fax Number: Alt. Phone Number: Birthdate: Email: Sex: Male Female Ethnic Identity code as stated in Part A, page 2: List below the three faculty members who best know your academic qualifications, including performance, potential, and motivation. Name Address Position and Institution
STATEMENT OF PURPOSE PART B2 Write a brief statement of purpose describing reason(s) for pursuing graduate or postbaccalaureate study. Include any additional information concerning your preparation which is pertinent to the objective specified. You may use the page provided or attach a type-written statement. I certify that the information submitted in this application is true, complete and accurate. I understand that any misrepresentation will be cause for denial of admission. Signature: Date:
CSUB S REGIONAL PROGRAMS C&I TECHNOLOGY PREPARATION CONTRACT Thank you for your application to the CSUB C&I Masters of Arts Degree Program. Our program is offered completely online. The technology statement is a required part of the admissions packet in order to ensure applicants have the technology skills necessary to interact with colleagues, students and instructors in an online environment. In addition to academic preparations, students in the C&I Master s Degree program need to have personal access to a computer and the Internet in order to complete classes. Technology success in the program includes the ability to: 1. Access the Internet; including performing searches, setting bookmarks, following links, and saving a web page. Have the ability to apply electronic search strategies, including the use of keyword searches and using Boolean operators; adhere to software licensing agreements and comply with copyright law and guidelines; locate/ retrieve information from remote sources; including using distant data for analysis. 2. Perform the following operations in a word processing program: copy, cut and paste, change size/ style, spell check text, format paragraph text; create: columns, tables, margins, and tab settings. 3. Use varied communication tools (e-mail, fax, chat, and threaded discussions) to participate in group projects. 4. Participate in electronic communities as a learner, initiator, contributor, or mentor. 5. Use multiple technology tools; including CD/DVDs, video cameras, scanners, digital cameras, etc. 6. Use e-mail; including send/receive, forward/reply, save/ archive, create/use address books, and send attachments. Program general technology requirements: 1. LiveText Software (2005), LiveText, LiveText Student Membership 2. Download a "no cost copy of the current version of Adobe Reader in preparation for reading assignments. 3. It is recommended that students have Microsoft Office (Word, Excel and PowerPoint). Students may purchase the student/teacher edition from many retailers. Documents created using Microsoft Works are not accepted for any reason. 4. Back up course work on a daily basis; disk failure or other loss of data is not an excuse when completing course work. By signing below, I acknowledge that I understand that I am applying for admission to an online distance education program and believe I am able to work successfully in an online environment. Applicant Name: Date: Applicant Signature: Your program admission is not complete until the agreement has been received by the program Evaluator. If you have questions regarding the technology expectations, please do not hesitate to contact our office at 661.654.3423.
Applicant: Please complete this section, then deliver or mail this form and self-addressed envelope to your reference. Ask your reference to return the letter to you in the attached envelope with his/her signature across the seal. Do not open the envelope or break the seal. Submit the sealed envelope with your application. Opened references will not be accepted. Please return to: Evaluator, Regional Programs California State University, Bakersfield 9001 Stockdale Highway- 30 BDC Bakersfield, CA 93311-1099 TO BE FILLED OUT BY CANDIDATE BEFORE THIS FORM IS GIVEN TO THE REFERENCE I am aware of the provisions of the Family Education Rights and Privacy Act. I hereby authorize the release of the information above to CSU Bakersfield. I realize that I will not view nor be informed of this evaluation form. Signature of Applicant has applied for admission to the Curriculum and Instruction Master s Degree program at CSU Bakersfield. This recommendation form should be completed by an individual who has knowledge of the applicant s knowledge, skills, and dispositions related to teaching. Please provide your judgment of the suitability of this candidate for the program according to the following dispositions: Disposition Description Evaluation (please circle one) Professional Collaboration The applicant works effectively with others. Reflective Practitioner The applicant demonstrates problem solving and critical thinking skills. Ethical Professional The applicant demonstrates ethical behavior, consistent with professional standards, obligations, and responsibilities. Student/Client Centered The applicant makes connections between and among individuals and maintains trusting relationships. Professional Leader The applicant demonstrates leadership skills such as effective communication and organization and the ability to ensure the advancement, welfare and safety of the students. Professional Competence The applicant demonstrates the potential to positively impact K-12 learners. COMMENTS: Please provide your contact information so that we may contact you if we need clarification: Print Name: Telephone: Signature: Position: Email: Date:
Application for Conditional Classification California State University, Bakersfield: MA Education Curriculum & Instruction Regional Programs Students with an undergraduate GPA between 2.7 and 2.9 can be admitted as Conditionally Classified if a reasonable expectation of successful completion of the C&I program can be demonstrated. Conditionally classified students must pass the first 12 units of the program with a grade of B or better. If you wish to be considered for Conditional Classification, please submit this form, along with the documentation required below, to the Regional Programs office. Name: Address: City: State: Zip Code: Phone: Email: Provide a well written narrative explaining each as it applies to your request: 1. The reason for your Conditional Classification Request. 2. Explain the factors which resulted in your low GPA and briefly, describe your plan of action to meet and maintain a GPA of 3.0 if admitted to the program. 3. Unique talents/qualities/experiences that you have and how completion of the C&I program will enhance those qualities. You must submit this form along with your supportive documentation to the program Evaluator. Be sure to sign and date this form before submission. Signature: Date: FOR OFFICE USE ONLY Overall GPA: Last 90 GPA: Verified by: Date: Application: Denied Approved es: Director/Coordinator Signature Date