Graduate Education Application Form

Personal Information

First Name

Last Name

Gender
-None- Male Female

Email

Phone

Mobile

Date of Birth (mm/dd/yyyy)

Place of birth

Are you a US Citizen?
-None- Yes No

If not, what is your country of birth?

What is your country of Citizenship

Location Information

Mailing Street

Mailing City

Mailing State
-None- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Mailing Zip

Mailing Country

Personal Questions

Have you ever been convicted of a felony
-None- Yes No

Have you ever been convicted of a misdemeanor
-None- Yes No

If yes, please explain

Church Information

Are you a Christian?
-None- Yes No

Name of Church

Church street address

Church city

Church phone number

Church email

Pastor's Name

Denomination

Church State
-None- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

High School Information

Name of high school

High school street address

High school city

Type of high school
-None- Public Private Home school Christian

High school graduation date
-None- before 2005 2006 2007 2008 2009 2010 2011 2012

GPA (estimated)

Have you ever been expelled or suspended
-None- Yes No

High school state
-None- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

High School Zip

ACT/SAT Score

Enrollment Information

What school?
-None- Residential Online

Type of student
-None- First-Time Freshman Transfer Re-Admittance Transient Special Non-Degree Audit Only Graduate Seminary

Expected enrollment term
-None- Fall 2010 Spring 2011 Summer 2011 Fall 2011

Intended enrollment status
-None- Full-time (12-18 hours) Three-quarter time (9-11 hours) Half-time (6-8 hours) Below half-time (0-5 hours)

Intended Degree
-None- Master of Education

Intended Major
-None- Educational Leadership Instructional Effectiveness English Education Undecided

Housing Plans
-None- Residence Hall Off-Campus Online- N/A

How did you hear about TTU?

List any previous colleges you have attended

Please explain why TTU is for you

I would like to room with

Please explain your transportation needs

I plan to participate in
Music program Baseball Cheerleading Men's Basketball Men's Cross Country Men's Soccer Volleyball Women's Basketball Women's Cross Country Women's Soccer Wrestling

Fathers Information (If under 25)

Father's First Name

Father's Last Name

Father's Street Address

Father's state
-None- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Father's zipcode

Father's city

Father's phone number

Father's email address

Mothers Information (If under 25)

Mother's first name

Mother's last name

Mother's street address

Mother's phone number

Mother's email address

Mother's state
-None- AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Mother's zipcode

Mother's city