University of South Carolina Aiken
ONLINE GRADUATE ADMISSIONS INFORMATION FORM
A $40.00 NON-REFUNDABLE FEE MUST BE RECEIVED BY THE GRADUATE OFFICE BEFORE THE APPLICATION IS PROCESSED
1. Social Security Number (enter your 9 digit SSN with no dashes, for example 123456789
2. Last Name First Name Middle or Maiden Name
3. Present Address:
Street: City: State: Zip:
4. Permanent Address:
5. Home Phone #: Area Code Number (numbers only)
6. Office Phone #: Area Code Number (numbers only)
7. Email Address:
8. Birth Date : 2 Digit Month 2 Digit Day 4 digit Year
9. Gender: Female Male
10. Are you a permanent US citizen? Yes No
If you are not a US citizen what is your country of citizenship: What is your country of birth:
11. Are you a legal resident of South Carolina? Yes Uncertain No Are you a legal resident of Georgia? No Yes Uncertain
List the city, county and state where you have lived for the past five years (list up to the last three residences for the past five years):
City, Cnty, ST: Dates (year to year)
12. Note: Admissions decisions are not affected by ethnic background. Information is requested for statistical reporting only.
Ethnic Group: Black, not Hispanic origin White, not Hispanic origin American Indian or Alaskan Native Asian or Pacific Islander Hispanic Other
13. Next of Kin:
Name: Phone Number: Area Code Number (numbers only)
Address: Street: City: State: Zip:
14. Intended Field of Study: M.Ed. in Elementary Education M.Ed. in Educational Technology M.S. in Applied Clinical Psychology
15. Term Applying For? Fall Spring Summer I Summer II Year Applying For? 2005 2006 2007 2008 2009 2010
16. Have you enrolled for GRADUATE credit at USC prior to this date? No Yes
17. Have you enrolled for GRADUATE credit at any other non-USC institution prior to this date? No Yes
18. List in chronological order all colleges and universities you have attended, including any work done at USCA. Official transcript(s) of academic work at each college attended (except coursework in the USC System) must be sent by that Registrar directly to the USCA Graduate Office.
Type in the college or university, the dates of attendance (from and to), the degree earned and date, and the major:
A.
B.
C.
D.
E.
19. Name on these records if different from that on line 2:
20. The required entrance exam I have taken is: GRE MAT No exam taken yet The score I received was:
Miller's Analogy Test:
Graduate Records Exam - Verbal: Quantitative: Analytical: Psychology Content (for Psychology only):
(Official test scores must be sent to the USCA Graduate Office)
If I have not yet taken the entrance exam, I will take the required entrance exam for my major (i.e. GRE, MAT) on:
21. List the names of persons whom you have requested to send recommendations:
By clicking the Submit button you agree that the above information is correct and to the best of my knowledge.
The University of South Carolina Aiken provides affirmative action and adheres to the principle of equal educational and employment opportunity without regard to race, color, religion, sex, creed, national origin, age, disability or veteran status. This policy extends to all programs and activities supported by the University.
The University of South Carolina Aiken is accredited by the Commission of the Southern Association of Colleges and Schools (1866 Southern Lane, Decatur, Georgia 30033-4097: Telephone number 404-679-4501) to award degrees at Level III (Master's Level). The University of South Carolina has hereby designated as the Section 504 coordinator. The University Affirmative Action Officer is located in the Human Services Division, University of South Carolina, Columbia, South Carolina, 29208.
