Office of Graduate Studies 186 High Street Farmington, ME 04938
Version Created February 2020
Master of Arts in Counseling
with an Emphasis in the Creative Arts
Application
Last Name _____________________________________ First Name ___________________________ Middle________________
Preferred First Name _____________________ Date of Birth ____________ Please share your pronouns _____________________
Email Address ____________________________________________ Phone Number _________________________
Home mailing address _________________________________________________________________________
Country of Birth: ________________________________________________________ Are you a US citizen? Yes No
If you are a US Permanent Resident, indicate alien registration number and submit a copy (front & back) of your Permanent Resident
Card. A# _______________
(Optional) Universities are asked by the federal government, accrediting associations, and college guides, among others, to describe
the racial/ethnic backgrounds of our students. To fulfill these requests, we ask you to answer the following questions:
Language(s) spoken at home ________________________________ Are you of Franco-American heritage? Yes No
Please indicate if you are Hispanic/Latino Yes No
Please select one or more of the following racial categories to describe yourself: American Indian or Alaska Native
Asian Black or African American Native Hawaiian or other Pacific Islander White Other
Education
Where did you receive your baccalaureate degree?
Institution ______________________________ Degree/Major ___________________ Minor _________________
If you have attended any University of Maine campus please share your name at that time if different from above
_________________________
If you have taken classes or been enrolled in a graduate program please list that institution and program
Institution ______________________________ Program _______________________
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Transcripts: Please provide official transcripts from each institution you have attended (at the undergraduate and graduate level).
Official transcripts must be sent directly from the above institutions to the Office of Graduate Studies. This office will obtain all UM
System school transcripts (UMA, UMF, UMFK, UMM, UM, UMPI, and USM).
* Applications are accepted on a rolling basis, and will be considered when complete.
For Office Use Only Date Received: ___________ Application
___________ Application Essay
___________ Official undergraduate transcript
___________ For consideration of transfer credits, official graduate transcripts and syllabi
___________ Recommendation 1
___________ Recommendation 2
___________ Current Resume
___________ Preferred start date
