ADMISSIONS
ONLINE GRADUATE APPLICATION FORM
APPLICATION INFORMATION
Given Name (or First): REQUIRED FIELD
Middle Name :
Surname (or Last): REQUIRED FIELD
Previous Surname :
 
(if applicable)
Social Security Number : REQUIRED FIELD
Home Phone : ( ) -
Work Phone : ( ) -
E-Mail address : REQUIRED FIELD
Current Mailing Address :
City :
State :
Zip :
Permanent Address :
City:
State :
Zip :
Sex :
Country of Citizenship :
Birth Date : / /
Birth Place :
ENROLLMENT INFORMATION
Proposed Graduation Program :
Request Entry For : Term         Year
Degree Sought :
Specialization :
(if applicable)
Intended Enrollment Status :
EDUCATION HISTORY
Have you ever attended graduate school? :
If Yes, when? :
Where? :
Some programs require standardized examinations. Have the testing agency send official test results to the Admissions office. If you have not yet taken a required examination, please indicate when you will do so.
Proposed Examination Date :
Graduate Record (Aptitude)
Date
Verbal Score
Analytical
Graduate Record (Advanced)
Date
Subject Score
Miller Analogies
Date
Subject Score
English - Second Language (TOEFL)
Date
Score
Others

List all colleges and universities attended. ONE copy of the official transcript from each institution attended must be sent directly to the Admissions Office.

APPLICATIONS WILL NOT BE PROCESSED WITHOUT ALL NECESSARY TRANSCRIPTS!
Name and Location of
Educational Institution
Entered
(Mo/Yr)
Left
(Mo/Yr)
Major
Degree
Awarded
Date
Awarded
List employment and military experience (include summer employment) for the past two years:
Employer Name :
Address :
City :
State :
Zip :
Employer Name :
Address :
City :
State :
Zip :
Employer Name :
Address :
City :
State :
Zip :
List academic honors, scholarships, fellowships, prizes, certificates, memberships, and any offices held, etc.
List evidence of creative or professional achievements; (a) published or other materials; (b) extracurricular activities or services (academic, community, etc.); or (c) inventions
FINANCIAL AID ASSISTANCE INFORMATION
Is your acceptance or admission contingent upon receipt of financial aid?
Have you received any type of financial aid?      If yes, please specify :
Do you qualify for veteran's benefits?
Is your tuition being paid by a third party, e.g., private company?
If yes, please specify :
Other forms of financial aid? (fellowship, merit)
ACADEMIC GOALS AND OBJECTIVES
Please discuss concisely, your academic objectives pertaining to the field in which you plan to study. Include contemplated research projects and professional career goals.
I certify that the information recorded in this application is correct. I agree to abide by the rules, policies, and regulations of Salem International University if I am admitted as a student.
Agree :
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