Application - Reading

ABOUT SSL CERTIFICATES

Thank you for your interest in the M.Ed. Program at Geneva College. A complete application package includes:

• This Form
• Official transcripts
• Your Resume
• Two Recommendations
• Copy of Certification

Admissions decisions are based on the entire package of information and are made by the Education faculty.

Starting Date: Fall (August) Spring (January) Summer (May) Year          Full-Time Part-Time Degree Seeking Certification Only Non-Degree             Track    Reading   Special Education

Personal Information
First Name:
Maiden Name:
Last Name:
Mailing Address:
City:
Province/State:
Zip:
Home Telephone:	( )-
Email:
Citizenship:	U.S. Other (Designate Country)
Please check one of the following (optional)
Native American African American Asian American	Hispanic American Caucasian/White American Other
Birthdate:	month day year
Soc. Sec. No:
Church Affiliation/Denomination:
How did you hear about our program?
Education Background
Certification area
Name of College/University
Graduation Date	month year
Degree Earned
Major
Minor
GPA
Name of College/University
Graduation Date	month year
Degree Earned
Major
Minor
GPA
Name of College/University
Graduation Date	month year
Degree Earned
Major
Minor
GPA
Graduate
Name of College/University
Graduation Date	month year
Degree Earned
Major
Minor
GPA
If no degree earned,specify amount of work completed and your major
Have you attended other colleges for graduate work?	Yes No
Employment
Are you presently employed?
Yes No
Job Title/Position
Employer/Organization
Address
Telephone & Area Code:	( )-
Work Fax #:	( )-
Do you intend to continue your employment should you be admitted the program? Yes No
Ask two people who are familiar with your previous academic or professional work to complete and return the recommendation form for the Master of Education. List the persons who will be completing the reports. Recommendation Form
I affirm that the information I have provided on this application form and all other admission application materials are complete, accurate, and true to the best of my knowledge. I understand that furnishing false or incomplete information on any part of this admission application material may result in cancellation of admission or registration, or both.
Signature
Date