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I am inquiring about the program. Please send (Western Carolina University)

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U.S.A. forms for Western Carolina University

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Graduate School
Application for Enrollment
Reference #:
Full-Time
Part-Time
Term
Concentration
Application Program:
Program / Degree:
MAED - Distance Educational Supervision
Special Program
Personal Data Section
Name:
Prefix
First (Given Name)
Middle
Last (Family Name / Surname)
Other Names Used (e.g. birth / maiden name)
Preferred Name
Mailing Address:
Telephone:
US/International
Mobile
Email Addresses:
Personal
E-Mail Address:
Catamount
E-Mail Address: (if applicable)
Birth:
Date: MM/DD/YYYY
Month:____________ Day:________Year:___________
Gender: Female Male
Residency
I certify that I am a bona fide resident of the state of
And have been a resident of that state from
(mm/yyyy)
Ethnicity and Citizenship:
Race
U.S. Citizen? NO YES
Country of Citizenship
Visa Number and Type
Resident Type
Admission Test Section
GMAT
Date Scheduled
Date Taken
GRE
Date Scheduled
Date Taken
MAT
Date Scheduled
Date Taken
IELTS
Date Scheduled
Date Taken
TOEFL
Date Scheduled
Test Type
Date Taken
MAED - Distance Special Education
JAMAICA
MASTER'S PROGRAM
Upon completion, submit a legible copy of your application form to learn@wcu.edu or WhatsApp: 828-507-7531
OR deliver to your local recruiter. Visit jamaica.wcu.edu to get their contact information
OR contact Owen Speid - on-site coordinator: 876-419-0417
Not Applicable
Please provide your complete address for our records.
Program Section
I am inquiring about the
program. Please send me
additional information.
I am interested in
starting with the next
cohort.
Please select one:
University Information Section
Campus Information:
Have you attended a graduate program at Western Carolina University?
NO YES
Are you completing this application to request a change of a current program at WCU?
NO YES
If you are applying to a program that offers assistance, would you be interested in a graduate assistantship?
NO YES
Military Applicant Information Section
Military Information:
(Applicant)
Are you currently serving or have you ever served in the United States Armed Forces?
NO YES
Are you a dependent or a spouse of a current or prior United States Armed Forces service member?
NO YES
What is your branch of service? Current Military Status What is your current or last pay grade?
Are you applying a military tuition benefit?
NO YES
Do you plan to use military or veterans
educational benefits while enrolled at the
institution? NO YES
If yes, which benefit do you plan to use?
Your current or last permanent duty station? City of your current or last home of record? State of your current or last home of record?
What is your legal city residence? What is your legal state residence? What is your legal residence date declared?
Date entered Active Service Discharge Date (actual or anticipated) If discharged, what was your final Duty
Station?
Military Family Information Section
Military Information:
(Family)
First Name Middle Name Last Name
Service Member Relationship Family Member Military Status Current or last pay grade of service member?
Do you plan to use military or veterans
educational benefits while enrolled at the
institution? NO YES
If Yes - Which benefit do you plan to use? Service branch of service member?
Current or last permanent duty station of
service member?
Current or last home city of record for service
member?
Current or last home state of record for
service member?
Legal city of residence for Service Member? Legal state residence for service member? Legal Residence Date Declared for service
member?
Date entered Active Service for
service member
Discharge Date (actual or anticipated)
for service member
If Discharge, final Duty Station for
service member?
Are you applying for
this military tuition
benefit?
NO YES
Upon completion, submit a legible copy of your application form to learn@wcu.edu or WhatsApp: 828-507-7531
OR deliver to your local recruiter. Visit jamaica.wcu.edu to get their contact information
OR contact Owen Speid - on-site coordinator: 876-419-0417
Previous Colleges and Universities Attended Section
Name of Institution
City / State
Dates Attended
( from / to)
Degrees Obtained
If your TOEFL or IELTS scores do not meet the Graduate School’s minimum score for admission, are you interested in the Intensive English Program at WCU? YES NO
Certification Statement Section
1. Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to disciplinary
sanction by any school, college, or university?
NO YES
2. Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime
NO YES
3. Do you have any criminal charges pending against you?
NO YES
4. Have you entered a plea of no contest or nolo contendere, or an Alford plea, to a misdemeanor, felony, or other
criminal charge; or received a deferred prosecution or prayer for judgment continued for such a charge; or
otherwise accepted responsibility for such a crime?
NO YES
5. Have you received any type of discharge from military service “other than an honorable discharge”?
6. If your education was or will be interrupted, indicate here and provide details in additional information section.
If you have answered yes to any of the six questions above, please explain the circumstances in this space and/or on a separate sheet of paper.
To the best of my knowledge, the information I have given on this application is complete, accurate, and truthful. I understand that any misrepresentation
of facts on this application may be cause for refusal of admission, suspension, or dismissal from the University.
I CONFIRM
SIGNATURE:
DATE:
The University of North Carolina and all of its constituent institutions are committed to equality of opportunity. There shall be no discrimination within the university against applicants,
students, or employees on the basis of race, color, religion, gender, age, disability, or national origin, consistent with the provisions of applicable state and federal law.
*If you received a degree from another University [not WCU], you will need to supply us with an official transcript.
NO YES
Upon completion, submit a legible copy of your application form to learn@wcu.edu or WhatsApp: 828-507-7531
OR deliver to your local recruiter. Visit jamaica.wcu.edu to get their contact information
OR contact Owen Speid - on-site coordinator: 876-419-0417
I understand that completion of this degree does not lead to teacher licensure in North Carolina
Signature: ______________________________________________
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Completed 1 September 2020

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