School of Graduate Studies Application Section 1: Candidate Information 1. Prefix - None -Mrs.Ms.Mr.Dr. 2. First Name * 3. Middle Name 4. Last Name * 5. Suffix - None -Jr.Sr.IIIIIIVVVIVII 16. What is your birth/maiden name? 6. Preferred Name 7. Permanent Address Line 1 * 8. Permanent Address Line 2 9. Permanent City * 10. Permanent State * 11. Permanent Zip Code * Format: 12345 OR 12345-6789 OR 123456789 OR A1B 2C3 12. Permanent Country BahamasCanadaUnited States 13. Permanent Phone Number * Format: 123-456-7890 14. Mobile/cell phone number Format: 123-456-7890 15. Email Address * Format: x@x.xx 17. Date of Birth (mm/dd/yyyy) * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year19191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 18. Gender * - Select -FemaleMale 19. Ethnicity - None -Hispanic/LatinoNot Hispanic/Latino 20. Race American Indian/Alaska Native(Original Peoples of the Americas)Asian (Including Indian subcontinent and Philippines)Black/African American (Including Africa and the Caribbean)Native Hawaiian or Other Pacific Islander (Original Peoples)`White (Including Middle Eastern) 21. Social Security Number Format: 123-45-6789 22. Marital Status - None -DivorcedMarriedMarriedSingleWidowed 23. Religious Affiliation - None -African Methodist/EpiscopalAgnosticAnglicanApostolicAssemblyBaptistBrethrenBuddhismCatholicChristian/non-denominationalChurch of ChristChurch of GodDisciples of ChristEpiscopalEvangical Free Church AmericaFreewill BaptistFreewill IndependentHinduHolinessJewishLatter Day SaintsLutheranMennoniteMethodistMissionary BaptistMoravianMormanMuslimNazareneNon DenominationalNone SpecifiedOrthodoxPentecostalPresbyterianProtestantQuakerRoman CatholicSeventh Day AdventistSouthern BaptistSpiritualist 24. Citizenship - None -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe 25. Citizenship Status Nonresident Alien Resident Alien US Citizen 26. Anticipated Academic Enroll Year * - Select -20192021 27. Anticipated Academic Enroll Term * Fall 28. Enrollment Status - None -Part Time 29. What is the highest Degree you've earned? - None -Associate of ArtsAssociate of ScienceBachelor of ArtsBachelor of ScienceCertified Public AccountantDoctorateGED CertificateHigh School DiplomaJuris Doctor (law)Master of ArtsMaster of ScienceMasters of Divinity College/University Information College/University 1 30. College/University Attended 31. College/University City 32. College/University State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 33. Beginning Attendance Date College/University Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 34. Ending Attendance Date College/University Attended Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 35. What degree have you earned? 36. College GPA College/University 2 37. College/University Attended 38. College/University City 39. College/University State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 40. Beginning Attendance Date College/University Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 41. Ending Attendance Date College/University Attended Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 42. What degree have you earned? 43. College GPA College/University 3 44. College/University Attended 45. College/University City 46. College/University State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 47. Beginning Attendance Date College/University Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 48. Ending Attendance Date College/University Attended Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 49. What degree have you earned? 50. College GPA College/University 4 51. College/University Attended 52. College/University City 53. College/University State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming 54. Beginning Attendance Date College/University Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 55. Ending Attendance Date College/University Attended Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 56. What degree have you earned? 57. College GPA Master of Education Requirements To be considered for admission to the M.Ed. program at Chowan University, applicants must submit Miller Analogies Test (MAT) directly from Pearson Assessment. Chowan University’s MAT code is 2564. (Note: If you have already taken the GRE, you may submit those scores in lieu of the MAT.) 58. Have you taken the MAT? * - Select -YesNo If not, when do you anticipate taking the assessment? * 59. Do you hold a current teaching license? * - Select -YesNo (Please submit a copy of your teaching license with your application materials.) 60. Effective Dates: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 61. Licensure Area(s): * 62. List any relevant professional employment or undergraduate clinical experiences. (School, Address, Position, Dates) * (Activity, Name of Organization, Years, Offices Held) 63. List any professional organizations and/or pertinent community service or civic activities in which you are involved. (Activity, Name of Organization, Years, Offices Held) Recommendations: List the three people whom you have asked to complete the Recommendation Form in support of your application. These people should have knowledge of your professional work or academic ability within the field of education. (Currently employed teachers should have one Recommendation Form completed by their principal.) Recommendation 1 64. Full Name * 65. Professional Title * 66. Institution/Organization * Recommendation 2 67. Full Name * 68. Professional Title * 69. Institution/Organization * Recommendation 3 70. Full Name * 71 .Professional Title * 72. Institution/Organization * Current Employer 73. Who is your current employer? 74. What is your current position? 75. Work Phone Number 76. Emergency Contact Name 77. First Name 78. Last Name * 79. Relationship to you * 81. Emergency Contact Phone Number * Background 80. Are you on academic/social probation at any other college? * Yes No 82. If yes, please explain the circumstances around your probation at the other school 83. Have you ever been convicted of a felony? * Yes No If yes, please explain the circumstances of your felony conviction 84. In the space provided, briefly explain your reason for applying to the School of Graduate Studies, including your educational and professional goals: * 85. Personal Statement: In a well-written essay, discuss your professional goals and explain how these goals relate to your educational, work, and life experiences. The essay should be 500-750 words. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.
