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Application for Admission: MA in Teaching (Initial Licensure)

* = Required Field

Program Information

* Program
Elementary
Secondary - if so, enter subject matter:

* Anticipated Start Term

Personal Information

* First Name Middle Name * Last Name Previous/Maiden Name * Date of Birth (MM/DD/YYYY)

* Sex MaleFemale

* Social Security Number (write "none" if you do not have one)

Mailing Address

* Address Line 1 Address Line 2 * City/Town * State/Province * Zip/Postal Code
* Country (if not in U.S.) * Phone (including area code)
Fax (including area code)* E-mail

Emergency Contact

Name Relationship Phone (including area code)

Citizenship & Military Status

* What is your citizenship status?
US Citizen
Permanent resident
Neither a citizen nor a resident (If you are not a U.S. citizen, you must read the international student requirements.

If not a US citizen, type of visa
Military Status

EDUCATIONAL BACKGROUND

Official transcripts will be required for all schools listed.

Bachelor's Degree From what institution did you graduate? Location (City/State)

What degree did you receive?
BS BA BFA

Date of Graduation

Additional Schools Attended

School #1 Location (City, State) Dates Attended Approx. # of Courses Degree Earned
School #2 Location (City, State) Dates Attended Approx. # of Courses Degree Earned
School #3 Location (City, State) Dates Attended Approx. # of Courses Degree Earned

* Title of current educator license:License number:

TOEFL Score(International Applicants Only)

EMPLOYMENT INFORMATION

Current Employer Position/Title Employer Address City * State/Province Zip/Postal Code
Work Phone (including area code)Work Fax (including area code)Work E-mail

Does your employer offer tuition reimbursement?
Yes No Not Sure

What percentage or amount?

Do you intend to apply for financial aid through Emmanuel College?
Yes No Undecided

Employment History

Please list your professional positions over the past three years.

Employer #1 Position City/State Dates

Full-time Part-time

Employer #2 Position City/State Dates

Full-time Part-time

Employer #3 Position City/State Dates

Full-time Part-time

ADDITIONAL INFORMATION

Why did you select the degree program to which you are seeking admission? What do you expect to achieve in this program?

Referral Information

How did you learn about Emmanuel College? Please check all that apply and specify your response.
Newspaper
Radio station
Website
MBTA/Commuter Rail ad
Emmanuel student or alumni
Information Session:
Date (MM/DD/YYYY) Location
Poster at work (which company?)
Other

Optional Information

How would you describe your ethnic heritage? (check all that apply)
American Indian or Alaskan Native
Asian or Pacific Islander
Black (non-Hispanic)
Hispanic
White (non-Hispanic)
Other

What is your religion?

PLEASE READ THE FOLLOWING:

In consideration of the undertaking by the Office of Graduate & Professional Programs to process this form, I agree that the information furnished in this application for admission, together with all information and materials of any kind received by the Office of Admissions from any source or prepared by anyone at its request, shall be completely confidential and shall not be disclosed to anyone including me and my family, except for situations specified in the Family Rights and Privacy act of 1975.

I understand that I am responsible for the submission of official transcripts of my academic records. Only those transcripts issued directly by the Registrar of each institution will be accepted.

Formal admission to Emmanuel College as a degree candidate is granted only after all admission materials have been received and all minimum standards are met.

I certify that the information provided in this application for admission are true and correct. I further authorize Emmanuel College to make appropriate inquiries when necessary to certify the accuracy of my records.

Emmanuel College is accredited by the New England Association of Schools.

Emmanuel College admits students of any race, color, religion, national and ethnic origin, or handicap to all rights, privileges, programs and activities generally accorded or made available to students at the College. The College maintains a policy of nondiscrimination toward all persons eligible to apply for scholarship and loan programs and other College-administered programs.

By submitting this form, I agree to the above.

Check here if you have not yet received an information packet, which includes the course schedule. We will be happy to mail a packet to you within the next week.