COLLEGE OF ARTS & SCIENCES

APPLICATION FOR GRADUATE ADMISSION

All materials submitted in conjunction with an application become the property of Georgia Southwestern State University and will not be returned.

Admission requested for: (Please Check One) *
Fall (August) Spring (Jan) Summer (June) Year 20

APPLICANT INFORMATION

Full Legal Name First (given) * Middle Last *
Permanent Mailing Address Street Address * Apt No.
City * State * Zip *
County Telephone (including Area Code) * Email Address*
Indicate other names used on official
records if different from above:		 First Middle Last
Contact in case of emergency Parent      Spouse      Guardian      Other
First Last Telephone (including Area Code)
Address Apt No.
City State Zip

CITIZENSHIP *

US Citizen Country of Citizenship (if not US) Visa Type
Non-Resident Alien
Resident Alien (copy of green card required)    

RESIDENCY STATUS *

Legal Resident of Georgia? *
Yes  If yes, how long?   (Years) (Months)   County
No  If no, legal state of residency

MILITARY STATUS

What is your Military Status Coding?
Not Applicable
Military Active Air Force
Military Active Army
Military Active Coast Guard
Military Active Marine
 Military Actice Navy
Military Veteran
Military National Guard
Military Reservist 		Dep/Spouse Active Air Force
Dep/Spouse Active Army
Dep/Spouse Active Coast Guard
Dep/Spouse Active Marine		 Dep/Spouse Active Navy
Dep/Spouse Veteran
Dep/Spouse National Guard
Dep/Spouse Reservist

BIOGRAPHIC INFORMATION

Birthdate * Gender Marital Status Ethnic Origin: Please answer the following two questions. (optional)

Place of Birth (City, State)
 Female
Male		 Single
Married
Divorced
Widowed
Separated

 Are you Hispanic or Latino? Yes No
What is your race? (Choose one or more.)
American Indian or Alaska Native
Asian
Black
Native Hawaiian or Pacific Islander
White

ACADEMIC INFORMATION *

Classification:  Regular Admission
Master of English
Classification:  Non-Degree Admission
Personal Development
Post Baccalaureate
List all colleges and universities you have attended or are attending, including Georgia Southwestern State University. Official transcripts are required from each institution. If you are currently enrolled, give the last expected date of enrollment.
Name of Institution Attendance From (mm/yy) Attendance To (mm/yy) Degree Earned (mm/yy)
Scores (no more than 5 years old) will be submitted from:
(Not required for 2nd Master's Degree)		 GRE Date taken or scheduled (mm/dd/yy)
Each applicant seeking regular admission must submit acceptable scores, on the GRE. All test scores must be requested by the student and mailed from the testing agency directly to: Georgia Southwestern State University, 800 Georgia Southwestern State University Drive, Americus, GA 31709.
I certify that all statements made in this application are complete and true. I also understand that falsification of or failure to provide information requested may result in my immediate dismissal and/or loss of all credits from the University. If my application is accepted and I become a student, I agree to abide by the published regulations of the University and the policies of the Board of Regents of the University System of Georgia.
Yes, I agree No, I do not agree. Do not process my application Date: 
Signature ______________________________________________