Name _______________________________ Social Security Number ___________________

Name on Previous Academic Records (if different from above) ___________________________

Mailing Address ________________________________ Phone Number (___)___________ _________________________________ _________________________________ Good until __________________

Birthplace ______________________________ Date of birth _______________________

Citizenship/visa status _______________________________Gender ____________________

Permanent Address ____________________________________________________________ _______________________________________________________________

Proposed quarter or semester of entrance _______________________________

Have you applied to this school previously? __________________ If yes, give date __________

Do you expect to be classified as a legal resident of the state?_____________________

What is your degree objective? (check one) Ph.D. __________ Psy.D. __________ M.A. __________

M.S. __________ Other _____

Program name to which you are applying ______________________________________ Area of specialization (if applicable) ___________________________________

GRE, MAT, TOEFL, AND TSE TEST INFORMATION:

GRE Exam Date _________ Scores: Verbal _____ Quan _____ Analy _____ Subject _____

MAT Exam Date _____________ MAT Score _______________

TOEFL Exam Date ____________ TOEFL Total Score _________

ETHNICITY: Please check only one.

• ___ American Indian/Alaskan Native
• ___ Black/African American
• ___ Chicano/Mexican American
• ___ Chinese/Chinese American
• ___ East Indian/Pakistani
• ___ Filipino/Pilipino
• ___ Japanese/Japanese American
• ___ Korean/Korean American
• ___ Latino/Latin American
• ___ Other Hispanic
• ___ Polynesian
• ___ Puerto Rican
• ___ Viet/Thai/Other Asian
• ___ White/Caucasian
• ___ Other (Please specify) ________________________

WORK IN PROGRESS: If you are currently attending a college of university, please list the work in progress. Name of Institution __________________________________
 

Department	Course number	Descriptive Title of Course	Units
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.	.	.	.
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.	.	.	.

LETTERS OF RECOMMENDATION: Please list the names and affiliation of persons from whom you have requested letters of recommendation.

 

Name and Title of Person	Name of Institutionn or Busuiness
.	.
.	.
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PERTINENT WORK EXPERIENCE: List employment occupation or activities pertinent to your graduate goals during or since your collegiate studies.
 
 
 
 

PUBLICATIONS/CONFERENCE PRESENTATIONS: If pertinent to your proposed field of study, please list your publications or papers presented at conferences.
 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________  ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ STATEMENT OF PURPOSE:
 

• State your general reasons for undertaking graduate work and your specific interest with respect to the program to which you are applying. The admissions committee must determine whether or not your objective can be satisfied within the program.
• You should  include:
• career objectives
• research interests and experience
• your intended area of specialization.
• If you are applying to an applied area, you should include your experiences in an applied setting.
• Also please give a brief occupational resume if any significant period has elapsed since you were last enrolled in an academic institution.
• Finally,  include any factors which are not covered elsewhere which you think the admissions committee should know.

• Describe why you have selected social work as a career.
• Describe your educational goals and expectations as well as your short and long term professional goals.
• Provide evidence of your capacity for graduate work.
• Explain why you are seeking graduate school education at this point in your career.
• Indicate briefly how will the program to which are applying will meet your needs.

The statement of purpose should be typed on 81/2 x 11 white paper.
For those applying to MSW and Ph.D. programs the statement should be 750 to 1000 words in length (about three to four pages).  For those applying to other MA programs (not social work) the statement should be 400 to 600 words in length.