Cedar Crest Application

Application for Graduate Study

This is a formal application for graduate admission to the college. In order to be processed you must request that official transcripts of all prior course work be sent to the Center for Lifelong Learning.

Thank you!

Personal Data

First Name:

MI:

Last Name:

Maiden Name

Other Name(s)
under which transcripts
may be issued:

Social Security No.:

Date of Birth:

Street:

City:

County:

State:

Zip:

Home Telephone Number .:

Work Telephone Number :

E-mail address:

Gender:

Citizenship

U.S. Citizen
U.S. Permanent Resident
Other

Type of Visa

Held Will Apply

Diversity Data

To help us report on cultural diversity, we ask students who are U.S. citizens or permanent residents to self-identify voluntarily. Answering this question is voluntary and optional. This information will not be used in admissions decisions.:

African American/Non Hispanic
Asian American
Ethnicity Unknown
Hispanic/Latino
Multi-Racial
Native American/Alaska Native
Native Hawaiian, Other Pacific Islander
White, Non-Hispanic
Other
No Response

Criminal History

Have you ever been convicted of a criminal offense (including juvenile court) other than a minor traffic violation
or are there criminal charges pending against you at this time?
Yes No

If you answered yes , please submit a letter of explanation.

Financial Aid

Do you plan to apply for Financial Aid?

Yes No

Will you be using an Employer Tuition Reimbursement Plan :

Yes No

Employer Name:

Educational Background

Please list, in chronological order, ALL colleges and universities you have attended, including Cedar Crest College

College/University

Location

Major

Dates Attended

DegreeAwarded

College/University

Location

Major

Dates Attended

DegreeAwarded

College/University

Location

Major

Dates Attended

DegreeAwarded

Undergraduate Major

Field :

Scholastic Honors :

Graduate & Professional Degrees

Field:

Graduate Degree Some graduate work; no degree No graduate work

State your undergraduate grade point average (on a 4.00 scale)

Entrance Date

Applying for Academic Year:

Fall 2009 Fall 2010

GRE

Test Date

Verbal

% Below

Quantitative

% Below

Analytical Writing

% Below

Recommendations
List the names and titles of those who will be providing letters of recommendation

Name:

Address:

Position:

Relationship to Applicant

Name:

Address:

Position:

Relationship to Applicant

Work Experience

Please list in reverse chronological order emplyment including service in the armed forces, Peace Corps, etc. (Do not list part-time or summer employment unless it is relevant to the graduate program.) Include dates, place, title and job duties.

Supplementary Education Information

Activities in professional, community and collegiate organizations

Publications, theses, awards, and creative work

I understand that any omission or misstatement of mine in this application, whenever discovered, may result in the voiding of my admission or registration and the receopt of no credit from Cedar Crest College. I further understand that from the time I file my application with Cedar Crest College it is my responsibility to know all the requirements and exemptions for my intended prpgram.
I understand and accept these conditions