Date_______________________
Indiana Univer
sity Southeast
Master of Science in Education and/or
Licensing Programs
General Advising and Information Session
Welcome to a General Advising and Information Session for the Graduate Program at IU Southeast. We
appreciate your interest in our program. We hope this informational session will help you make decisions
about your future in Graduate Studies.
Please provide us with the information below. We will keep this form on file in case we need to contact
you in the future.
NA
ME________________________________________________________________
ADRESS ____________________________________________________________________
_____________________________________________________________________
CELL PHONE ( )___________________ HOME PHONE ( )____________________
EMAIL ADDRESS_____________________________________________________________
P
LACE OF WORK_____________________________________________________________
J
OB TITLE ____________________________
IUS 10digit Student ID_000________________ Date of Birth
__________________________ (These two items provide information so we can enter you
into the system and help facilitate your application should you choose to apply.)
Which program(s) most interest you?
_____MS in Elem
entary Education
_____MS in Secondary Education
_____MS in Elementary Education with a
Concentration in:
_____ENL
_____Gifted and Talented
_____Reading
_____Technology
_____MS in Secondary Education with a
Concentration in:
_____ENL
_____Gifted and Talented
_____Reading
_____Technology
_____MS in Counseling:
_____Elementary
_____Middle School
_____High School
_____Not sure
_____Post -Masters license in Educational Leadership
_____Indiana
_____Kentucky
_____License only:
_____ENL
_____Gifted and Talented
_____Reading
_____Technology
_____Plus 30 (Indiana)
_____Rank I (Kentucky)
_____ENL
_____Gifted and Talented
_____Reading
_____Technology
_____Educational Leadership
B
ased on what you know so far, what parts of our program are attractive to you?
B
ased on what you know so far, what parts of our program are less attractive to you?
When w
ould you like to begin taking courses? ____ Fall 201___
_____Spring 201___
_____Summer 201___
Optional Information:
(This information helps us track interests in our programs to report to our accrediting agency.)
G
ender: ____Male Ethnicity: ____Hispanic
____Female ____American Indian or Alaska Native
____Asian or Pacific Islander
____African American
____White (European American)
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome