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Application for Admission to Graduate Studies Form

 

Thank you for taking advantage of one of Valley City State University's Master of Education program. Please complete the following in its entirety. Failure to complete all of the informational items will cause delays in processing your registration. Should you have any questions, you may contact the office of Graduate studies at the following number: (701) 845-7303 or email: graduate@vcsu.edu.



PERSONAL DATA

1. Legal Name:
Last
First
MI
Former (if applicable)
2. Social Security #**: 3. Gender:
4. Date of Birth:
5. Are you a US citizen?*: Yes   No     If no, in which country do you hold citizenship?:
6. If not a US citizen, are you a permanent resident?*: Yes   No     If yes, give alien registration number:
7. Ethnic Origin**:
a. Are you Hispanic/Latino*? Yes No
8. Permanent Address:
Street and/or PO Box:
City:
State:
County:
Country:
Zip Code:
9. Mailing Address(if different):
Street and/or PO Box:
City:
State:
County:
Country:
Zip Code:
10. Telephone: Home:
Area Code:  Phone: 
Cell:
Area Code: Phone:
11. Email Address:

ENROLLMENT INFORMATION

12. Indicate Enrollment Term Requested:
Fall year
Spring year
Summer year
13. Please indicate intended education goal:
Earn Master of Education-Teaching and Technology
Earn Master of Education-Technology Education
Earn Master of Education-Technology Education plus North Dakota Licensure
Earn Master of Education-Library and Information Technologies
Earn Master of Education-English Language Learners
Non Degree
*If you checked 'Non Degree', Enter the number of graduate course(s):
Please read the following policy (# 6.3.c.):
No more than nine (9) credits taken under the non-degree status with a grade of B or higher can be transferred to any official program of study should there be, at any future date, a decision to seek degree classification.

EDUCATIONAL HISTORY
14. List in chronological order all colleges, universities, other institutions of higher education which you have attended or are attending.
Click 'Add College Row' to enter more than one college, or 'Remove College Row' to remove college from the list below.
  College/University State Dates Attended Major/Study Degree GPA
1

WORK HISTORY
15. List in chronological order Professional,Teaching, Administration, and/or other relevant experiences.
Click 'Add Employer Row' to enter more than one college, or 'Remove Employer Row' to remove college from the list below.
  Employer Location Dates Employed
1

INFORMATION

16. Do you now, or have you live(d) in North Dakota? Yes   If yes, list the years (e.g. 1988-present or 1985-1997):
No    If no, in what state are you are a resident? List years
17. Are you a member or a Veteran of the Armed Services? Yes   If yes, will you apply for benenfits: Yes   No    
No    
18. Are you an active member or the spouse of an active duty member of the armed forces of a North Dakota National Guard unit? Yes  
No    
19. Where did you hear about VCSU's Masters program? Other:

SIGNATURE

20. By submitting this application, I understand that the information presented on this form will be used to evaluate my
application for admission to Valley City State University. I certify that all statements are complete and true as of this date.
If this information changes, I will notify the Office of Graduate studies of the Changes.

*NOTE: This information is required for statistical purposes only and will not affect the status of your application. The information will not be used in a discriminatory manner and your response is voluntary.
**Disclosure of your Social Security Number is voluntary. Social Security Numbers are used as an individual ID number for record keeping and administrative purposes. Failure to provide a SSN may cause delays in administrative services. Such as financial aid processing.
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