CSJ Graduate School Application

General Information

First Name*

Middle Name*

Last Name*

Sex

Male
Female

Date of Birth*

Social Security Number*

Mailing Address (street, city, state, zip code)*

Email*

Primary Phone*

Country of Citizenship*

United States
Permanent Resident
Other

If "other" indicate country of citizenship*

Place of Birth (please include: City, State & Country)*

Entry Term*

Fall
Spring

Do you intend to apply for on-campus housing?**

Yes
No

Enrollment Status*

Full Time
Part Time

Please choose an acadedemic area of study*

Education
Psychology & Human Services
Master of Business Administration

I am seeking initial teacher licensure*

Yes
No

I am seeking a graduate program in:*

General Education
Elementary Education
Special Education
Reading (this program requires current teacher certification)
Secondary Education
Secondary Education with a concentration in Social Studies/History
Secondary Education with a concentration in English
Post-Baccalaureate Teacher Certification Social Studies
Post-Baccalaureate Teacher Certification English

I am seeking a*

MS Clinical Psychology
MS Clinical Mental Health Counseling
MS School Counseling (PRAXIS I required, program leads to initial licensure)
MS Community Counseling
MS Community Counseling: Alcohol and Substance Abuse Counseling
Graduate Certificate in Alcohol and Substance Abuse Counseling

Please list the names of the individuals who will be submitting letters of recommendation on your behalf.*

Please list all colleges or universities you have attended. List the most recent college or university first. Please include: Dates Attended, Name of College or University, City and State, Major, and Degree Earned*

List all graduate level courses you have completed. Please include: Course Name, Institution, Grade, Credit Hours, and Date. Please note: the number of graduate transfer credits accepted is determined by the program to which you are applying. Please refer to the catalog or contact the Division Chairperson for additional information.

List any academic honors and/or scholarships you have received, as well as professional organizations in which you hold membership.

Employment Information

Employment Status*

Full Time
Part Time
Not Employed

Employer*

Please include Employer, Job Title, Address, City, State, Zip, Work Phone

To what other graduate schools are you applying?

Have you ever been dismissed from an educational institution or program?

Yes
No

Please Explain*

Have you ever been convicted of a felony?

Yes
No

Please explain*

Essay

Please upload a Microsoft Word or PDF File of your Essay.

Graduate Application

Graduate Admissions Application

General Information

Employment Information