OPTIONAL INFORMATION
*APPLICATION FOR MASTER LEVEL PROGRAMS (FOR STATISTICAL PURPOSES ONLY)
✓CHECKED ITEMS
IMMACULATA UNIVERSITY
COLLEGE OF GRADUATE STUDIES
IMMACULATA, PA 19345-0500
(610) 647-4400 EXT. 3211, 3212
APPLICATION FOR: (Please Check)
1. Degree Programs: (Master's Programs) 2. Certification Programs Supervisory Certifications:
_____Applied Communication _____Elementary School Counselor _____Curriculum and Instruction
_____Cultural and Linguistic Diversity _____Secondary School Counselor _____Special Education
_____Counseling Psychology _____Principal K-12 _____Specialty Area
_____Educational Leadership/Administration _____Elementary Certification
_____Music Therapy _____School Psychologist
_____Nursing (MSN) _____Secondary Certification
_____Nutrition Education _____School Nurse
_____Organization Leadership _____Special Education Certification
3. Certificate Programs:
_____TESOL _____Health Care _____Organizational Effectiveness
4. _____Enrichment Study (Official Undergraduate transcript required) 5. _____Post Graduate Study (Master’s degree required)
APPLICATION PROCEDURE FOR DEGREE PROGRAM:
1. Complete this form and send it with $40.00 application fee to: Director of Graduate Admission, Immaculata University, Box 500, Immaculata, PA 19345-0500.
2. Official transcript from each undergraduate and graduate school attended.
3. Two (2) recommendation forms appraising applicant’s capacity for graduate study.
4. Official scores for the Miller Analogies Test (MAT) or the Graduate Record Examination (GRE) sent directly from the testing center.*
5. Official score on Test of English as a Foreign Language (TOEFL) for International Students.
6. Goals Statement.
APPLICANT’S DATA (Please type or print)
NAME________________________________________________________________________________________________________________________________
First Last Middle Maiden
ADDRESS_____________________________________________________________________________________________________________________________
Street City State Zip County
TELEPHONE__________________________________________________________________________________________________________________________
Home Work e-mail
✓DATE OF BIRTH __________________________________ ✓SOCIAL SECURITY NUMBER______________________________ (Required for financial aid)
✓RACE_______________ ✓SEX _______ Female _______ Male ✓VETERAN______________ ✓U.S. CITIZEN_______________
FOREIGN STUDENTS:
PLACE OF BIRTH __________________________________ COUNTRY OF CITIZENSHIP________________________TYPE OF VISA____________________
City Country
EDUCATIONAL DATA
MILLER ANALOGIES TEST (MAT) Date ______________________________ Score ____________________________________
GRADUATE RECORD EXAMINATION (GRE) Date ______________________________ Score ____________________________________
TOEFL Date ______________________________ Score ____________________________________
*Applicants with an undergraduate GPA of 3.0 or higher are not required to submit test scores for MA programs. Test scores are not required for certifica-
tion only.
COLLEGES AND UNIVERSITIES ATTENDED (List most recent study first)
Institution Location Date of Entrance Date of Leaving Date of Degree Degree
Graduate Study
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Undergraduate Study
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
UNDERGRADUATE MAJOR____________________________________________MINOR__________________________________________________
ADMISSION REQUESTED FOR: SUMMER I: __________ SUMMER II: __________ FALL: __________ SPRING:__________
Please list the names and titles of persons whom you have asked to complete letters of reference (professional and/or academic references only):
Name Title
______________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
Goals Statement
Please attach a one page essay addressing the following: Discuss your professional goals and how graduate study at Immaculata University will enable you
to achieve those goals.
Emergency Contact
NAME OF PERSON TO BE CONTACTED IN CASE OF EMERGENCY_______________________________Telephone __________________________
Applicant Statement
ALL APPLICANTS PLEASE READ AND SIGN THE FOLLOWING
I understand that appropriate Immaculata personnel will have access to my application student record and that withholding information requested or giving
false information may make me ineligible for admission to the College and subject to dismissal. With this in mind, I certify that the above statements are
correct and complete and if admitted, I agree to abide by the published policies, rules and regulations of Immaculata University.
___________________________________________________________ __________________________________________________________
Signature Date
Non-Discriminatory Policy
Immaculata University is committed to the principle of equal educational opportunity without discrimination because of a
person’s race, gender, ethnicity, religion, age, national origin, color, disability, marital status, veteran status or other
classifications protected by law or University policy.
Campus Safety and Protection Services and Statistics can be accessed at www.immaculata.edu/students/safetyandprotection.index.htm
*REFERENCE FORM
IMMACULATA UNIVERSITY
COLLEGE OF GRADUATE STUDIES
IMMACULATA, PA 19345-0500
(610) 647-4400 EXT. 3211, 3212
Applicant must complete and sign the following statement. The request is in compliance with the Family Education Right and Privacy Act of 1974.
( ) I waive my right to view this letter of recommendation in my file. ( ) I do not waive my right to view this letter of recommendation in my file.
______________________________________________________________________________________________________________________________________
Signature Date
NAME OF APPLICANT_______________________________________________________________PHONE____________________________________________
Address_______________________________________________________________________________________________________________________________
Degree Sought______________________________________________________________Specialization________________________________________________
How well do you know the applicant? ( ) Very Well ( ) Fairly Well ( ) Slightly
How long have you known the applicant? ____________________________________________________________________________________________________
In what capacity have you been associated with the applicant?____________________________________________________________________________________
Please rate the applicant on each of the following characteristics. Indicate any additional comment which would be of assistance in evaluating the applicant’s potential.
SCHOLASTIC ABILITY Excellent Very Good Good Unsatisfactory No chance to observe
Oral Expression
Written Expression
Intellectual Curiosity
Ability to Integrate Information
Ability to Work Independently
PERSONAL CHARACTERISTICS
Dependable
Responsible
Tolerant
Cooperative
My recommendation is: ( ) Strong and without reservation ( ) With confidence ( ) With reservation ( ) I do not recommend
Comment:_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Please type/print your:
NAME_________________________________________________________________________________________________________________________________
SIGNATURE____________________________________________________________________________________________________________________________
POSITION______________________________________________________________________________________________________________________________
INSTITUTION___________________________________________________________________________________________________________________________
ADDRESS______________________________________________________________________________________________________________________________
DATE__________________________________________________________________________________________________________________________________
