The Campolo College of Graduate and Professional Studies


PERSONAL INFORMATION
______________________________________________________________________________________

Full Name:
    (First) (Middle) (Last)

Mailing  Address:

Street: Gender: Male Female
City:  
State: Choosing and ethnicity/race
(Click on link to see separate page with explanation)
Zip: Hispanic/Latino  Yes   No
Country  Race (please choose one or more options below)
Home Phone: American Indian or Alaska Native
Work Phone: Asian
E-Mail Address: Black or African American
Date of Birth: Native Hawaiian or other Pacific Islander
Country of Birth: White
Citizenship: How did you hear about Eastern University?
Social Security Number:
VISA (if international student in US) I am affiliated with Mission Year.
Age:
Denomination:

  
COURSE OF STUDY
______________________________________________________________________________________

When do you wish to enroll for classes?


Are you applying for full or part time studies?
(For Traditional programs only)

Program of Interest:

MA in School Counseling, MS in School Psychology, MA in Counseling (Clinical)) ONLY start in the Fall. The certification only programs (School Psychology cert only and School Counseling cert only) start any term -- Fall, Spring, Summer I or Summer II
If you are applying for Teaching Certification Only, please answer the questions in the next section.

 
TEACHING CERTIFICATIONS ONLY (For Teaching Certification Applicants Only)
Please indicate the area of teaching certification to which you are applying.

Note:  Early Childhood Only and Special Education Only Certifications require that you already hold another certification.
Please list all teaching certifications you currently hold:

If applicable, please select one of the partnerships below.
 

Location Preferences
Preferred Location
(for Traditional programs only)
Preferred Location
(for Fast Track NonProfit Management only)

Preferred Location
(for FastTrack MBA only)

Preferred Location
(for School of Leadership and Development Programs only)

Preferred Location
(for Fast Track Health Administration and Health Services only)

 

 

EDUCATION INFORMATION
______________________________________________________________________________________

List all colleges, universities, graduate and professional schools attended, starting with the most recent. 
Submit an official transcript from each institution attended.  GPA should indicate your final cumulative
grade point average from that institution.  Please do not round GPA numbers.

Please indicate other names that your transcripts may be under: 

Institution: 

Location:  

Dates Attended:      GPA: 

Degree and Year Awarded: 


Institution: 

Location:  

Dates Attended:      GPA: 

Degree and Year Awarded: 

 

Institution: 

Location:  

Dates Attended:      GPA: 

Degree and Year Awarded: 


 

EMPLOYMENT INFORMATION
______________________________________________________________________________________

Full-Time Employment
Please describe all full-time positions held, starting with the most recent.  Please include military service and
full-time volunteer work.  It is important that you fill in this section.  Submission of a current resume is also recommended.

Current Employer:    

Dates of Employment:

Address:  

City:      State:      Zip: 

Primary Responsibilities: 

Phone Number: 

Will your employer be making a financial contribution to your tuition?  Yes No 

What percentage

 

WRITTEN ESSAY DIRECTIONS AND AUTHENTICITY STATEMENT





PLEASE READ AND SIGN

I UNDERSTAND THAT I AM RESPONSIBLE FOR THE SUBMISSION AND RECEIPT, BY THE UNIVERSITY, OF OFFICIAL TRANSCRIPTS OF MY RECORDS, AND THAT THE UNIVERSITY WILL ACCEPT, AS ITS OWN PROPERTY AND FOR ITS PERMANENT FILE, ONLY THOSE TRANSCRIPTS ISSUED DIRECTLY BY EACH INSTITUTION I HAVE ATTENDED.
FULL ADMISSION TO EASTERN UNIVERSITY AS A DEGREE CANDIDATE IS GRANTED ONLY AFTER ALL ADMISSION MATERIALS HAVE BEEN RECEIVED, ALL ADMISSION REQUIREMENTS MET, AND FORMAL NOTIFICATION HAS BEEN ISSUED.
I HAVE ALLOWED NO ONE TO ASSIST ME IN THE READING, WRITING OR EDITING OF MY ESSAY. I UNDERSTAND THAT I AM ALLOWED ONLY ONE SUBMISSION OF MY WRITING SAMPLE, AND I GIVE PERMISSION TO EASTERN UNIVERSITY TO USE MY ESSAY FOR INTERNAL RESEARCH PURPOSES.
I CERTIFY THAT THE INFORMATION WHICH I HAVE HEREIN PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE AND REALIZE THAT ANY FALSIFICATION OF INFORMATION MAY RELEASE THE UNIVERSITY FROM CONSIDERING MY APPLICATION FOR ADMISSION OR MAY LEAD TO DISMISSAL FROM THE UNIVERSITY AT A LATER DATE.

Signature: Date:

Please note that by clicking on “submit” above you are giving Eastern University permission to contact you via email. You can ask to be removed from our contact list at any time.

Eastern University is accredited by the Middle States Commission on Higher Education (MSCHE) and does not discriminate in any of its policies,
programs or activities on the basis of gender, race, handicap, marital or parental or ethnic origin.
Per the "Electronic Signature in Global and National Commerce Act of January 2000", Eastern University accepts the above electronic signature as valid  and legal.

 

Eastern University
The Campolo College of Graduate and Professional Studies
Department of Admissions
1300 Eagle Road
St. Davids, PA 19087-3696
gpsadm@eastern.edu
(610)341-5972


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