COLLEGE OF EDUCATION
GRADUATE PROGRAMS
APPLICATION FOR ADMISSION
12/13-0430
ADMISSIONS CHECKLIST FOR GRADUATE EDUCATION PROGRAMS
University of Mary Washington
121 University Blvd. • Fredericksburg, VA 22406-7239 • 540/286-8030 • Fax 540/286-8085
admissions.umw.edu • graduate@umw.edu
Thank you for your interest in the University of Mary Washington.
You may complete the enclosed application or submit an online application, but be sure all requirements
listed in sections 1, 2, and 3 below have been completed. The online applications and forms are available at
admissions.umw.edu/graduate.
1. Complete all forms listed below and submit with your application fee:
Application (Don’t forget to sign!)
Honor System Agreement
Virginia In-State Tuition Form
2. Submit the following:
Essay questions (See instructions on application.)
Résumé of your work experience
Passing Praxis Core scores or applicable SAT, ACT, and/or VCLA scores (initial licensure applicants only)
Passing Praxis II scores (Recommended, initial licensure applicants only)
Copy of Virginia teacher’s license (professional development or added endorsement applicants only)
Three letters of recommendation (For education leadership applicants only. Distribute to at least
one supervisor.)
3. Send a transcript request to all the colleges you’ve attended:
Request official transcripts from each and every college or university you attended, even if the
courses were transferred elsewhere. Duplicate the enclosed form if necessary.
There may be a fee, so be sure to call, email, or check the website for each institution prior to sending
the transcript request form.
4. Mail or deliver to:
University of Mary Washington
Office of Admissions
121 University Blvd.
Fredericksburg, VA 22406-7239
Note: A faculty-initiated interview may be required. The Faculty Admission Committee will review your
application with the following criteria in mind: knowledge of content in endorsement area, commitment to
teaching, understanding of the responsibilities inherent in teaching, skills in communication, and potential for
success in graduate school.
Please call the Office of Admissions at 540/286-8030 or
email graduate@umw.edu with your questions.
Monday through Thursday, 8:30 a.m. - 6:30 p.m.; Friday, 8:30 a.m. - 5 p.m.
UNIVERSITY OF MARY WASHINGTON
GRADUATE EDUCATION PROGRAMS
APPLICATION FOR ADMISSION
UNIVERSITY OF MARY WASHINGTON
For the term beginning
Fall
Spring
Summer Year___________
Education program you are applying for:
Master of Education with Initial Teacher Licensure
Master of Education – Advanced Programs for Licensed Teachers
Postgraduate Programs for Professional Development or Added Endorsement (Educational Leadership, Gied Education, Literacy Specialist,
Special Education, Teaching English as a Second Language)
Certicates (Autism, Teaching English as a Second or Foreign Language)
Other _________________________________________________________________
PERSONAL DATA
Legal N ame ______________________________________________________________________________________________________________
Enter name exactly as it appears on passports or other ofcial documents. Last/Family First Middle (complete) Jr., etc.
Prefer to be called (nickname) _______________________________ Former last name(s) if any ________________________________________
Email Address ___________________________________________ Home Phone ___________________________________________________
(Area Code) Number
Cell Phone _______________________________________________ Work Phone ___________________________________________________
(Area Code) Number
(Area Code) Number
Mailing Address __________________________________________________________________________________________________________
Number and Street
________________________________________________________________________________________________________________________
City or Town State Country ZIP Code or Postal Code
Best way and time to contact me: _____________________________________________________________________________________________
Occupation ______________________________________________ Employer ______________________________________________________
Do you plan to use tuition reimbursement from your employer? Yes No
Are you applying for a graduate assistant position?
Yes No
Are you applying for conditional admission through the ELS Language Center?
Yes No
Citizenship: U.S. citizen Dual U.S. citizen; please specify other country of citizenship _____________________________________________
U.S. Permanent Resident visa; citizen of __________________________________________________________________________
Other citizenship - Country: ____________________________________ Visa type: _____________________________________
All non-citizens are required to include documentation of their status with their application.
Do you wish to apply for Virginia in-state tuition (based on Virginia domicile?)
Yes No
If yes, please state your Virginia city or county of residence.
_______________________________________________________________________
If yes, include the completed Application for Virginia In-State Tuition Rates with your application for admission.
e following items are optional. Answers to these questions will not be used in a discriminatory manner.
Sex:
Female Male Birth date ________________________________________________________________________________
Social Security number (Excluding your Social Security number may delay the registration process) ________________________________________
If you wish to be identied with a particular race or ethnic group, please select the one that best describes you:
African American, Black Asian or Pacic Islander White, Non-Hispanic
Native American, Alaska Native Hispanic or Latino Multiracial
Are you Hispanic/Latino?
Yes, Hispanic or Latino (including Spain) No Please describe your background __________________________
Regardless of your answer to the prior question, please select one or more of the following ethnicities that best describe you:
American Indian or Alaska Native (including all Original Peoples of the Americas) Please describe your background _________________________
Are you enrolled? Yes No Please enter tribal enrollment number _______________________________
Asian (including Indian subcontinent and Philippines) Please describe your background ___________________________________
Black or African American (including Africa and Caribbean) Please describe your background ___________________________________
Native Hawaiian or Other Pacific Islander (Original Peoples) Please describe your background ___________________________________
White (including Middle Eastern) Please describe your background ___________________________________
How did you learn of University of Mary Washington?
Newspaper Information Session Friend or Colleague Radio Other ________________________
PLEASE TYPE OR PRINT in the information below and return this form with your $50 non-refundable application fee to:
University of Mary Washington • Office of Admissions • 121 University Blvd. • Fredericksburg, Virginia 22406-7239
540/286-8030 • Fax: 540/286-8085 • Email: graduate@umw.edu
GRADUATE EDUCATION PROGRAMS
APPLICATION FOR ADMISSION
EDUCATION
Please mark your highest level of education:
Bachelor’s Degree Master’s Degree Post Master’s or Certicate Graduate, level unknown Doctorate
List the dates you took or plan to take Praxis Core (teacher licensure candidates only): ________________________________________________
Please provide a copy of your ocial Praxis Core scores or qualifying SAT, ACT, or VCLA scores.
List all colleges and universities attended (full- or part-time) beginning with the current or most recent – including UMW.
Transcripts from all schools listed are required for admission.
________________________________________________________________________________________________________________________
College or University Location-City/State Dates of Attendance Degree Earned Name when enrolled
________________________________________________________________________________________________________________________
College or University Location-City/State Dates of Attendance Degree Earned Name when enrolled
________________________________________________________________________________________________________________________
College or University Location-City/State Dates of Attendance Degree Earned Name when enrolled
Please indicate your status in the U.S. Armed Forces: No relationship Currently serving Previously served Current dependent
For veterans and members of our Armed Services, please show your DD-214 to the Oce of Graduate Admissions to receive priority registration.
ENROLLMENT
Do you have a Virginia collegiate professional or graduate professional teaching license? Yes No
What endorsement? ___________________________________________________ Date license expires: ________________________________
Provide evidence of teaching license on college/university transcript, letter from school system, or copy of license certicate.
I plan to be a:
Part-time student Full-time student
PROGRAM
A M.Ed. INITIAL TEACHER LICENSURE
Please check below the endorsement you plan to pursue.
B M.Ed
. FOR LICENSED TEACHERS
Elementary
Middle
Choose one from list:
English
History and Social
Sciences
Mathematics
Science
Secondary
Choose one from list:
Biology
Chemistry
Computer Science
Earth Science
English
History and Social
Sciences
Marketing
Mathematics
Physics
Pre K–12
Choose one from the list:
Art
ESL
Foreign Language
___________________________________
specify language
Music (Vocal/Choral)
Instrumental
K–12 Special Education
General Curriculum
Adapted Curriculum
Diverse Student Population
Special Education
Teaching English as a Second Language
Educational Leadership
General Curriculum
Literacy Specialist
Adapted Curriculum
C POSTGRADUATE PROGRAMS
Educational Leadership
Special Education
Teaching English as a Second Language
Gied Education General Curriculum
Literacy Specialist
Adapted Curriculum
D CERTIFICATES
Autism
Teaching English as a Second or Foreign Language
Have you ever applied to or attended UMW? Yes No
Have you ever been convicted of a crime other than a trac violation?
Yes No
Have you ever been convicted of a felony?
Yes No
Have you ever been convicted of a misdemeanor involving children or drugs?
Yes No
If yes, please attach an explanation.
Response Required
UNIVERSITY OF MARY WASHINGTON
ESSAY QUESTIONS Response should be two to three typed, double-spaced pages for each essay.
INITIAL TEACHER LICENSURE WITH M.Ed. OPTION
a) Why are you seeking teaching credentials? Why do you feel qualied to teach the subject/grade level of the endorsement you seek?
b) Discuss a current issue in education and why you think it is important. Support your stance.
M.ED. FOR LICENSED TEACHERS, CERTIFICATE, AND POSTGRADUATE APPLICANTS
a) What do you hope to gain from the M.Ed. program? What contributions do you feel you can make to the program as a participant?
b) Select a current instructional issue and discuss why you believe it is important. Support your stance.
EDUCATIONAL LEADERSHIP
a) Discuss a current issue in education that you might face as an educational leader.
b) Write a statement of purpose in which you discuss your current and future leadership goals. Include in your response background experiences
(personal and professional) that helped prepare you for a career in this eld.
Include a résumé (no more than three typed pages) of your education and your paid and volunteer work experiences.
THE HONOR SYSTEM: A WAY OF LIFE AT UMW
e Honor System is fundamentally a code of personal integrity. It
means that students of the University of Mary Washington accept the
challenge to make their word of honor a pledge of absolute truthfulness
in all matters that fall within the Honor Code. It is a commitment to a
way of life characterized by loyalty to the highest ideals of individual and
collective ethical responsibility. — Dr. Edward Alvey, Dean Emeritus
STATEMENT OF NON-DISCRIMINATION
e University of Mary Washington subscribes to the principles of equal
opportunity and armative action. e University does not discriminate
on the basis of race, color, religion, disability, national origin, political
aliation, marital status, sexual orientation, sex, or age in recruiting,
admitting, and enrolling students or in hiring faculty and sta members.
e University will not recognize or condone student, faculty, or sta
organizations that discriminate in selecting members. Complaints of
discrimination or questions should be directed to the AA/EEO Ocer of
the University.
COMMUNITY VALUES
Several elements contribute signicantly to the fulllment of the
University’s mission. One is the encouragement of, and respect for,
individual and cultural diversity. e University also insists upon
an atmosphere of civility and
tolerance consistent with the ideals of a
community of scholars. Toward that end,
the University embraces a
statement of community values and expectations concerning the behavior
of its members. is statement declares that:
e University of Mary Washington is an academic community dedicated
to the highest standards of scholarship, personal integrity, responsible
conduct, and respect for the individual. We hold among our foremost
common values:
n
e importance of personal integrity as reected in adherence to the
Honor Code,
n
e right of every individual to be treated with dignity and respect at all
times,
n
e acceptance of and respect for diversity in our community and
adherence to the University’s Statement of Non-Discrimination, and
n
e freedom of intellectual inquiry in the pursuit of truth.
As members of the University community, we refuse to tolerate behavior
that in any way compromises or threatens these values.
PLEASE READ THE HONOR CONSTITUTION:
students.umw.edu/honor-system
UMW HONOR PLEDGE AND TERMS OF APPLICATION
I, as a student at the University of Mary Washington, do hereby
accept the Honor System. I have read the information about the
Honor System, understand it, and agree to abide by its provisions.
Accordingly, I resolve to refrain from giving or receiving academic
material in a manner not authorized by the instructor, from illegally
appropriating the property of others, and from deliberately falsifying
the facts. I acknowledge that, in support of the Honor System, it is my
responsibility to report any violations of the Honor Code of which I
am aware, and that it is my duty to participate as an honor trial juror if
called upon to serve, unless ocially excused.
I realize that in the event of a violation of the Honor Code, a plea of
ignorance will not be acceptable, and that such a violation could result
in my permanent dismissal from the University. I further pledge that I
shall endeavor at all times to create a spirit of honor, both by upholding
the Honor System myself and helping others to do so.
I have read and understand the expectations outlined in the “Statement
of Community Values and Behavioral Expectations” and the “Statement
of Non-Discrimination.”
I understand that this application is subject to all terms and conditions,
nancial and otherwise, set forth in the current catalog and to all
ocially announced changes.I agree to accept all terms and conditions,
nancial and otherwise, which are in eect during the entire period
of enrollment.
I also understand that I cannot be licensed to teach in the
Commonwealth of Virginia if I have ever been convicted of a felony.
I certify that the information given in this application is correct to
the best of my knowledge and belief. My signature below indicates
that I accept the obligations and conditions of the Honor System.
Applicant’s Signature _____________________________________________________________ Date _________________________
IMPORTANT: Please reread this application and make sure that all blanks have been lled in. Incomplete forms will be returned, and the processing
of your application may be delayed.
I acknowledge responsibility for all tuition and fees resulting from my acceptance of an oer of admission to the University of Mary Washington.
UNIVERSITY OF MARY WASHINGTON
Please submit this form to complete your Application for Admission if you are claiming entitlement to Virginia in-state tuition pursuant to section
23-7.4, Code of Virginia. Supporting documents and additional information may be requested. All questions must be answered.
Section A - Student Information
1) Name of applicant ________________________________________________________________________________________________________
2) Social Security number (Optional) __________________________________ 3) Date of birth ___________________________________________
4) Citizenship U.S. U.S. permanent resident Non-U.S. Please specify visa type _______ Exp. date ________ (Please provide copy of I-94)
5) How long have you lived in Virginia? _____ year(s) _______ month(s)
6) Where have you lived, in the sense of physical presence, during the last two years? (List current address rst.)
Street address City State ZIP code From To
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
7) Employment information for at least one year prior to the date for which in-state tuition rates are sought (If not employed, or if retired, please indicate.):
Street address City State ZIP code From To
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Yes No
8) Do your parents/legal guardian provide 50% or more of your
nancial support or claim you as a tax dependent?
9) a.) If you are married, do you wish to claim eligibility for
in-state tuition rates based on your spouses domicile?
b.) If yes, does your spouse provide more than 50% of your
nancial support?
10) Do any of the following characteristics apply to you?
Place a check beside all that apply.
Age 24 or older as of the rst day of the term in which you intend to enroll
Veteran or active duty member of the U.S. Armed Forces
Graduate or rst-professional student
Ward of the court or was a ward of the court until age 18
If both parents are deceased, no adoptive or legal guardian
Legal dependents other than a spouse
11) In the last tax year did you le a state return to any state
other than Virginia? If yes, please explain: ________________
12) For at least one year immediately prior to the term in which
you are claiming in-state status, will you have led a tax
return or paid income taxes to Virginia on all earned
income? If no, please explain: __________________________
13) Are you a registered voter in Virginia?
Date registered ______ Original ______ Re-registered ______
14) Do you hold a valid Virginia driver’s license?
Date issued _________ Original ________ Renewal ________
If no, indicate your driver’s license status:
Hold in another state _______ Not licensed ______
Yes No
15) Did you own or operate a motor vehicle registered in
Virginia during the last year?
If no, indicate registration status:
Registered in another state ____
Did NOT own or operate a motor vehicle ____
16) Are you or is your spouse an active duty member of the U.S.
armed forces?
If no, continue to Question 17.
If yes, who is a member? Self _____ Spouse ____
and answer the following:
a.) Are Virginia income taxes paid on all military income?
If yes, as of what date? _______________________________
Where were you stationed on that date? _________________
Please submit a copy of the most recent leave and earnings statement.
b.) If you are in the military, or if your spouse is, are you assigned to a
permanent duty station in Virginia?
If yes, as of what date? _______________________________
Where are you stationed? _____________________________
Please submit a copy of the military orders permanently assigning
you or your spouse to this station AND a copy of the military ID card
showing your relationship to the military member.
17) Answer this question only if you live outside Virginia but work in Virginia:
Will you have lived outside Virginia, been employed in Virginia,
earned at least $15,080, and paid Virginia income taxes on all taxable
income earned in this commonwealth, for at least one year
prior to the term in which you will enroll?
If yes, please submit verication of employment, including dates and salary,
a copy of the most recent Virginia tax return, and a year-to-date pay stub.
I certify under penalty of disciplinary action that the information I have provided is true.
___________________________________________________________ __________________________________________________________
Signature of applicant Date
Last First Middle
Application for Virginia
In-State Tuition Rates
University of Mary Washington • Oce of Admissions • 121 University Blvd. • Fredericksburg, Virginia 22406
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signature
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Section B - Parent, legal guardian, or spouse
is section must be completed by the applicants parent, legal guardian, or spouse, who during the last tax year claimed the applicant as a dependent,
or who, for the 12 months immediately preceding the rst day of classes, has provided more than half of the applicants nancial support.
1) Name of
parent legal guardian spouse ____________________________________________________________________________
2) How long have you lived in Virginia? _______ year(s) ________month(s)
3) Where have you lived, in the sense of physical presence, during the last two years? (List current address rst.)
Street address City State ZIP code From To
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
4) Employment information for at least one year prior to the date for which in-state tuition rates are sought (If not employed, or if retired, please indicate.):
Street address City State ZIP code From To Full-time/part-time
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Yes No
5) In the last tax year, did you le a state return to any state
other than Virginia? If yes, please explain: __________
_______________________________________________
6) Will you have claimed the applicant as a dependent on
your federal and Virginia income tax return for the tax year
prior to the term in which the applicant will enroll?
If no, please explain: _________________________
7) Will you have provided more than half of the applicants
nancial support for at least 12 months prior to the
term in which the applicant will enroll?
If no, please explain: _______________________________
8) For at least one year immediately prior to the term in which the
applicant is claiming in-state status, will you have led a tax return
or paid income taxes to Virginia on all earned income?
If no, please explain: _______________
9) Are you a registered voter in Virginia?
Date registered _____ Original ________ Re-registered _____
If no, indicate your registration status:
Registered in another state ______ Not registered _______
10) Do you hold a valid Virginia driver’s license?
Date issued _________ Original ________ Renewal ________
If no, indicate your drivers license status:
Hold in another state _______ Not licensed ______
11) Did you own or operate a motor vehicle registered in
Virginia during the last year?
If no, indicate your auto registration status:
Registered in another state ____
Did NOT own or operate a motor vehicle ____
Yes No
12) Are you or is your spouse an active duty member of the U.S.
armed forces?
If no, continue to Question 13.
If yes, who is a member? Self ______ Spouse _____
and answer the following:
a.) Are Virginia income taxes paid on all military income?
If yes, as of what date? _____________________________
Where were you stationed on that date? ______________
Please submit a copy of the most recent leave and earnings statement.
b.) Are you or your active-duty spouse assigned to a
permanent duty station in Virginia?
If yes, as of what date? _______________________________
Where are you stationed? ____________________________
Please submit a copy of the military orders permanently
assigning you or your spouse to this station AND a copy of the military
ID card showing the applicant’s relationship to the military member.
13) Answer this question only if you live outside Virginia but
work in Virginia:
Will you have lived outside Virginia, been employed in Virginia,
earned at least $15,080, and paid Virginia income taxes on all
taxable income earned in this commonwealth, and claimed the
applicant as a dependent for federal and Virginia income tax
purposes for at least one year prior to the term in which the
applicant is claiming in-state status?
If yes, please submit verication of employment, including dates
and salary, a copy of the most recent Virginia tax return, and a
year-to-date pay stub.
I certify that the information I have provided is true.
____________________________________________________________ ___________________________________________________________
Signature of applicant Date
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UNIVERSITY OF MARY WASHINGTON
TRANSCRIPT REQUEST
University of Mary Washington
121 University Blvd. • Fredericksburg, VA 22406-7239 • 540/286-8030 • Fax 540/286-8085
admissions.umw.edu • graduate@umw.edu
To the student: Fill out this form completely and mail to all colleges and universities you have attended. There may be a
fee, so be sure to call or email each institution prior to sending this transcript request form. Duplicate as needed.
To the institution: Please send a copy of an official transcript to:
University of Mary Washington
Office of Admissions
121 University Blvd.
Fredericksburg, VA 22406-7239
q Also, please send an unofficial transcript for my personal use to the mailing address below.
I have included a transcript request fee of $ _____________________
Social Security number (Optional)____________________________________ Today’s date _____________________
Name ____________________________________________________________________________________________
First Middle Last
Previous name _____________________________________________________________________________________
Address __________________________________________________________________________________________
City _____________________________________________________ State ___________ ZIP _____________________
Phone ___________________________________________________
Dates I attended ___________________________ Year of graduation (if applicable) ______________________________
____________________________________________________ ____________________________________
Signature Date
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TO BE COMPLETED BY APPLICANT
Applicant: _____________________________________________________________ SSN (optional): __________________________________
Name of person recommending applicant: _________________________________________________________________________________
e Family Educational Rights and Privacy Act of 1974 as amended by PL 93-380 allows candidates for admission to waive their right of access to
condential recommendations. While we do not require that you waive your right to read this recommendation, we do believe that such a waiver
encourages a more candid and useful recommendation. If you agree to waive your right to see this recommendation, please sign the statement below.
I hereby waive my right of access to this recommendation and any appropriate attachments. is waiver is eective insofar
as the recommendation is used solely for the purpose of admission to a graduate degree or certicate program.
Applicant’s Signature: _____________________________________________________ Date: _________________________
GRADUATE DEGREE
APPLICANT RECOMMENDATION
TO BE COMPLETED BY RECOMMENDER
e person whose name appears above is applying for admission to a graduate program at the University of Mary Washington. Your candid
assessment of this applicant will greatly assist us in making a decision that is best for both the applicant and the program. We appreciate your
time and eort in providing this recommendation.
When you have completed the recommendation, please do the following:
1. Mail, fax, or email the recommendation directly to the University,
Or
2. Seal the recommendation in the envelope, sign your name across the ap, and return it to the applicant.
How long have you known the applicant? _____________________________________________________________________________________
I have known this applicant as an/a:
Undergraduate student
Graduate student
Co-worker
Employee
Other
I have served as the applicant’s:
Direct Supervisor
Instructor
Employer
Co-worker
Other
(over please)
COLLEGE OF EDUCATION
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Please give us your appraisal of the applicant in terms of the qualities below. Rate the applicant in comparison to other graduate school applicants,
school administrators, or other representative groups you have known.
Top 5% Top 25% Average Lower 25% Not Observed
Exceptional Above Average Below Average
Integrity
Motivation for graduate work
Ability to work independently
Ability to work with others
Written communication skills
Oral communication skills
Leadership potential
Teaching performance
Professional commitment
Ability to solve problems
Organizational skills
Judgment
Ability to motivate self and others
Intellectual ability
What do you consider to be the applicant’s particular strengths or talents?
Please feel welcome to add any additional comments regarding the applicant’s strengths and/or weaknesses in regard to completing a graduate
degree program.
Do you recommend this applicant for admission to a graduate degree program?
Strongly recommend
Recommend
Recommend with reservation
Do not recommend
May we contact you regarding this applicant?
Yes
No
Signature:
____________________________________________________________________ Date: ___________________________________
Printed Name: ________________________________________________________________ Title: ___________________________________
Organization: ____________________________________________________________________________________________________________
Email _______________________________________________________________________ Phone: __________________________________
RETURN THIS COMPLETED FORM TO:
University of Mary Washington • Oce of Admissions • 121 University Blvd.
Fredericksburg, Virginia 22406-7239 • 540/286-8030 • Fax: 540/286-8085 • admissions.umw.edu/graduate • Email: graduate@umw.edu