Through
Name: _______________________________________________________________________________________
Last
First
Middle
______________________________________________________________________________________________
Social Security Number Date
of Birth (optional) Citizenship
Home
Address:
_______________________________________________________________________________
Street
City State (province) Zip Code
Work
Address:
_______________________________________________________________________________
Street
City State
(province) Zip Code
Home
Phone:
______________________________
Work Phone:
___________________________________
Cell
Phone: _________________________________ FAX Number: __________________________________
Email
Address:
_______________________________________________________________________________
List
chronologically all undergraduate and graduate schools attended:
|
Dates of Attendance |
Name
and Address of Institution |
Degree Date |
Degree Title |
Major
Field |
Grade Point Average |
|
|
|
|
|
|
|
|
|
. |
|
|
|
|
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Optional: Ethnic Background of Students
In order for the University to meet its Federal
reporting obligation regarding the ethnic background of students, we ask you to
complete the following information. This
information is for statistical purposes only. No individual will be personally
identified in any reporting of this information. You are not required to
provide this information, but it can help the University in obtaining grant and
scholarship assistance for students.
Please check the one box that
best describers your ethnic origin:
5 non-US
Resident 5 Hispanic 5 Asian or Pacific Islander
5 Native American or Alaskan Native 5 Black, non-Hispanic 5 White, non-Hispanic
Honors, awards,
scholarships, certificates received:.
____________________________________________
______________________________________________________________________________________________________________________________
Are
you or have you ever been a teacher? 5 Yes 5 No If yes: 5 Elementary 5 Secondary 5 K-12
Sources
of funding for your proposed studies at Franciscan University of
Steubenville: Initially, the Ohio Core
Grant followed by:
_________________________________________________________________
Type of certification/licensure sought: __________________________________________________
Students
on unclassified status do not automatically acquire regular status for a
graduate degree at Franciscan university. Students admitted to unclassified
status may apply for admission to a degree program at any time. Upon admission
to regular degree status, appropriate credits earned in unclassified status
could be accepted as part of the degree requirements. Transient students must
submit a letter of authorization from their own dean in lieu of official
transcripts.
List
chronologically all employment since you received your undergraduate degree:
Date of Employment:
__________________________________________________________
Name and Address of
Institution: ________________________________________________
Date of Employment:
__________________________________________________________
Name and Address of Institution:
________________________________________________
Date of Employment: ___________________________________________________________
Name and Address of Institution:
________________________________________________
List
all certifications and/or licenses:
Cert./Lic. Number:
Cert./Lic. Number:
Cert./Lic. Number:
List of
the names and addresses of three persons who will recommend you. (Letters of reference will have to be completed
by these people if the candidate is accepted.)
Name:
____________________________________________________ Date:
___________________________
Position or Title:
_____________________________________________________________________________
Address:
____________________________________________________________________________________
Name:
____________________________________________________ Date:
___________________________
Position or Title:
_____________________________________________________________________________
Address:
____________________________________________________________________________________
Name:
____________________________________________________ Date:
___________________________
Position or Title: _____________________________________________________________________________
Address:
____________________________________________________________________________________
In you own handwriting,
state your reasons for wanting to enter the Franciscan University of
Steubenville Master of Science Program, what you expect to gain from it, and
what your plans and ambitions are for the future. (Use additional paper if necessary)
False information on this
application is grounds for immediate dismissal from this program. I hereby make application for admission to
the Franciscan University of Steubenville/Jefferson County ESC collaboration to
become part of the cohort to complete the CORE Initiative.
I Certify
that all information provided in this application is accurate and true.
Signature:
______________________________________________________ Date:
_____________________
Franciscan
University of Steubenville admits students of any race, color, national and
ethnic origin, disability, and sex to all rights, privileges, programs and
activities generally accorded or made available to students at the school as
required by Title IX of the 1972 Educational Amendments.
Attention: Core Application Review
2023
Sunset Boulevard,
Phone: 740-283-3347 Fax:
740-283-2709