Fillable KEENE STATE COLLEGE Application for Graduate Study in (Keene State College)

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KEENE STATE COLLEGE Application for Graduate Study in (Keene State College)

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Wisdom to make a difference.
Graduate Admissions | Keene State College | 229 Main Street | Keene, NH 03435-2605
gradstudies@keene.edu | keene.edu/gradstudies/
KEENE STATE COLLEGE
1
Application for Graduate Study in Education
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GENERAL INFORMATION
Preferred Application Dates
Keene State College considers applications on a rolling
admissions basis, however, students are encouraged to apply
well in advance of scheduled classes. Applicants who submit all
required materials by the dates listed below will receive prompt
attention. Those who apply later risk possible delays or blocks to
course registration and access to financial aid.
MARCH 1 for programs that begin with SUMMER classes
APRIL 1 for programs that begin with FALL classes
NOVEMBER 1 for programs that begin with SPRING classes
Keene State College reserves the right to close admissions,
irrespective of the preferred application dates, once class
capacity has been reached. Upon acceptance, applicants
are required to pay a nonrefundable enrollment services fee.
Academic Calendar
Summer courses may begin in May, June or July depending on
individual program requirements.
The fall semester starts the fourth week of August and ends in
early December.
The spring semester starts mid-January and ends in early May.
Financial Aid
No matter when you plan to enroll in an academic program, you
should complete the Free Application for Federal Financial Aid
(FAFSA) online at www.fafsa.ed.gov. The closer you can complete
the FAFSA to March 1 for the following academic year, the sooner
your request for financial aid will be evaluated. Please do not
wait until you are admitted into a program before completing
the FAFSA. Requests for financial aid are evaluated after KSC
receives FAFSA results and the applicant has been admitted into
an approved program.
Does your academic program require summer course work? If so,
it is your responsibility to bring this to the attention of a financial
aid counselor to determine if you are eligible to receive financial
aid during the summer
All students admitted into a master’s, post-master’s, or
post-baccalaureate program are eligible to apply for financial
assistance. In order to receive financial aid, master's and
post-master's students must register for at least 5 credits in
a term while post-baccalaureate students must register for
at least six credits.
For financial aid purposes, full-time and part-time enrollment
status for fall, spring, and summer is determined according to
the following table:
Program Academic Level Credits Enrollment Status
Master’s Graduate 5-8 Part-time
9 or more Full-time
Post-Master’s Graduate 5-8 Part-time
9 or more Full-time
Post-Baccalaureate Undergraduate 6-11 Part-time
12 or more Full-time
Visit keene.edu/gradstudies/ and select “Financing Your Education” for
more information.
STEP 1: REQUIREMENTS FOR ALL PROGRAMS
Forward all application materials to: KSC Graduate Admissions,
229 Main Street, Keene, NH 03435-2605.
• Completed application form with signature (refer to the
preferred application dates listed above)
• Nonrefundable application fee – The $50 fee is waived for
KSC alumni, current students and pre-K to 12 professional
educators. All others make check or money order payable to
Keene State College or pay by credit card.
• Official transcripts from all prior colleges or universities
attended (undergraduate and graduate). Applicants must hold
a bachelor’s degree from an appropriately accredited institution
of higher education, with a minimum grade point average (GPA)
of 2.50. Preference will be given to those with a GPA of 2.75
or higher. A GPA below 2.50 may be considered if one of the
following conditions are met.
- Calculation of last 60 attempted credits results in a GPA of
2.75 or higher.
- Earn 12 approved credits with a GPA of 3.50 or higher
- Score at or above the 50th percentile on the Graduate Record
Exam (GRE) verbal, analytical or quantitative subtest
• Copy of current certification as a teacher or professional
educator from a state department of education. This
requirement may be waived if passing scores for the Praxis tests
are submitted.
• Passing scores for the Praxis tests in reading, writing, and
mathematics. Having earned a master’s degree does not exempt
an applicant from this requirement. The Praxis test requirement
will be waived if the applicant has a current certification as a
teacher or professional educator. Sample tests, registration
forms, location, and fee information may be obtained by visiting
the Education Testing Service website: www.ets.org.
• Essay follow directions on page iii
• Three KSC Applicant Recommendation Forms (two
sides) completed by three different professional references.
A professional reference may include; college or university
professors, employers or supervisors, and professional
colleagues. Members of your family and friends are not
considered to be professional references. Letters of
recommendation written for employment are not acceptable.
2
Application for Graduate Study in Education
Wisdom to make a difference.
EDUCATIONAL LEADERSHIP
Master of Education Degree:
Educational Leadership (36 credits)
Post-Master’s Certification Program:
Educational Leadership (27 credits)
The certification associated with these programs is School
Principal (grades K to 12).
• Candidates for both programs must have a minimum of three
years of full-time experience working with children and youth
as a qualified educator in an approved educational setting.
Five years of full-time experience is required before the New
Hampshire Department of Education will grant certication as
a principal (grades K to 12).
• Candidates for both programs must be employed at least
half-time in an approved educational setting for the duration
of the program.
• Candidates for the Post-Master’s Certication Program must
have earned a master’s degree in an appropriate field.
Apply to the Master of Education Degree: Educational Leadership
by checking Item 2 under PROGRAM SELECTION on the
application form (p. iii).
Apply to the Post-Master’s Certification Program: Educational
Leadership by checking Item 3 under PROGRAM SELECTION
on the application form (p. iii).
SCHOOL COUNSELOR
Master of Education Degree:
School Counselor (48 credits)
Post-Master’s Certification Program:
School Counselor (30 credits)
The certification associated with this program is Guidance
Counselor (grades K to 12).
• Preference will be given to candidates who have a minimum
of two years (or the equivalent) of relevant life experience in
addition to undergraduate program completion.
• Preference will be given to candidates who have a minimum
of 300 hours of experience with children and youth in an
appropriate educational setting. Post-master’s candidates
must meet the minimum criteria.
• Candidates for the Post-Master’s Certication Program must
have earned a master’s degree in a field related to counseling
or social work.
Apply to the Master of Education Degree: School Counselor
by checking Item 4 under PROGRAM SELECTION on the
application form (p. iii).
Apply to Post-Master’s Certification Program: School Counselor
by checking Item 5 under PROGRAM SELECTION on the
application form (p. iii).
• Complete formal interview with KSC faculty member
designated by graduate admissions.
• A copy of alien registration card, if applicable.
If you are an international applicant, please review the additional
requirements specied under INTERNATIONAL APPLICANT.
All programs have additional requirements or prerequisites that
are listed in STEP 2.
STEP 2: ADDITIONAL CRITERIA FOR
EACH PROGRAM
CURRICULUM AND INSTRUCTION
Master of Education Degree:
Curriculum and Instruction (36 credits)
Three options exist for completing this degree.
Option 1A - Professional Development
This is a two year, part-time program for working teachers
interested in advancing their careers.
• Candidates must have a minimum of one year of full-time
teaching experience working with children and youth in an
appropriate pre-K to 12th grade educational setting.
• Preference will be given to candidates who are employed at
least half-time in an approved educational setting for the
duration of the program.
• Preference will be given to candidates who have a minimum
of two years of relevant life experience, or the equivalent, in
addition to undergraduate program completion.
• Apply to this option by checking box 1A under PROGRAM
SELECTION on the application form (p. iii).
Option 1B - Transfer 12 to 24 Articulation Agreement credits
This is a one year, part-time program for working teachers who
earned certification through a post-baccalaureate program at an
approved institution like Granite State College.
• The conditions listed in Option 1A above apply.
The complete eligibility criteria for the award of transfer credit is
available at keene.edu/gradstudies/.
Apply to this option by checking box 1B under PROGRAM
SELECTION on the application form (p. iii).
Option 1C - New Teacher As Leader
This is a one year, full-time intensive degree for recent graduates
from an approved educator preparation program or currently
certified teachers.
• Candidates must be certied or be recommended for
certification by September 1.
Apply to this option by checking box 1C under PROGRAM
SELECTION on the application form (p. iii).
3
Application for Graduate Study in Education
Wisdom to make a difference.
SPECIAL EDUCATION - M.Ed. or Certification only
The certification associated with these programs is General
Special Education (grades K to 12).
Master of Education Degree:
Special Education (32-38 credits)
Option 6A - M.Ed. with Certification
Recent college graduates typically completed this program in one
year, full-time. Working teachers typically complete certification
courses in year one and research courses in year two.
• Preference will be given to candidates who are currently
certified by a recognized state department of education in
Early Childhood, Elementary, or Secondary Education or have
successfully completed a certification program in one of these
areas at a recognized institution. Recent graduates must be
recommended for certification by September 1.
• Candidates must be employed at least half-time in an approved
educational setting or be enrolled in an approved internship for
the duration of the program.
• Candidates must have a minimum of 300 hours of experience
within the last three years with children and youth in an
appropriate K to 12 educational setting.
Apply to this option by checking box 6A under PROGRAM
SELECTION on the application form (p. iii).
Option 6B - M.Ed. Only - Transfer 12 to 26 Articulation
Agreement credits
This is a one year, part-time program for working teachers who
earned certification through a post-baccalaureate program at an
approved institution like Granite State College.
• The conditions listed in Option 6A above apply.
The complete eligibility criteria for the award of transfer credit is
available at keene.edu/gradstudies/.
Apply to this option by checking box 6B under PROGRAM
SELECTION on the application form (p. iii).
Graduate Educator Certification:
Special Education (20-26 credits)
Option 6C - Certication Only, non-degree 1 year intensive
This program is for professional educators or recent graduates
from an approved educator preparation program who seek
certification in General Special Education.
• The conditions listed in Option 6A above apply.
Apply to this option by checking box 6C under PROGRAM
SELECTION on the application form (p. iii).
POST-BACCALAUREATE TEACHER
CERTIFICATION
This is a non-degree-bearing program completed at the
undergraduate level.
• Preference will be given to candidates who have a minimum
of 300 hours of experience with children and youth in an
appropriate educational setting and a minimum of two years
(or the equivalent) of relevant life experience in addition to
undergraduate program completion.
• Preference will be given to candidates who submit passing
scores for the standardized content tests (typically content
knowledge and essay) required by the New Hampshire
Department of Education.
Sample tests, registration forms, location, and fee information may
be obtained by visiting the Education Testing Service website:
www.ets.org.
Apply to the Post-Baccalaureate Teacher Certification program
by checking one option from Items 7 to 22 under PROGRAM
SELECTION on the application form (p. iii).
International Applicants
If you are not a U.S. citizen, you are an international applicant.
If transcripts of course work you did at a foreign college or
university are being forwarded to KSC, you must have the
transcripts evaluated by a professional service such as World
Education Services, Inc. (www.wes.org), and the transcripts must
be accompanied by a certified English translation. In addition,
all international applicants must demonstrate proficiency in the
English language.
For international applicants:
• Complete the application.
• Enclose the $50 application fee.
• Submit transcripts of all college preparatory education and/
or college- or university-level coursework (a certified English
translation must accompany the transcripts).
• Ofcial Language Tests - If the language of instruction for the
majority of your education has been taught in any language
other than English, submit official test results for one of the
following:
1. Test of English as a Foreign Language (TOEFL)
Paper Based Test, Computer Based Test, or Internet
Based Test.
2. International English Language Testing System (IELTS).
• Submit a Certication of Finances form. This form is available
through the Graduate Studies Ofce at Keene State College.
Call 603-358-2497 or e-mail gradstudies@keene.edu. Please
note that information disclosed on the Certification of Finances
has no bearing on the admissions decision.
Refer to the PREFERRED APPLICATION DATES and forward
your application, fee, and all required materials to Graduate
Admissions, Keene State College, 229 Main Street, Keene, NH
03435-2605.
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Application for Graduate Study in Education
Wisdom to make a difference.
i
Please TYPE or PRINT clearly
APPLYING FOR:
❏ January 20____ ❏ Summer 20____ ❏ September 20____
Social Security number *
– –
Date of birth
Month/Day/Year
Gender
❏ Male
❏ Female
FAMILY INFORMATION Optional for applicants who are over 24 years of age and financially independent.
Are you a U.S. citizen?
❏ Yes ❏ No
If you are not a U.S. citizen, please specify:
Country of birth ____________________________
Country of citizenship _______________________
Type of Visa _______________________________
Native language ____________________________
TOEFL test dates ___________________________
1. Are you Hispanic or Latino?
❏ Yes, go to question #2
❏ No, go to question #3
2. Which of the following best describes your
Hispanic origin or descent? Mark one.
❏ Mexican or Chicano
❏ Puerto Rican
❏ Cuban
❏ Other Hispanic – Specify ________________
3. What is your racial background?
Check all that apply
❏ American Indian or Alaska Native
Specify tribal affiliation(s) _________________
❏ Native Hawaiian or other Pacific Islander
❏ Asian
❏ Black or African American
❏ White
Have you been a New Hampshire resident for
the past 12 months?
❏ Yes ❏ No
If yes, for how long? ________________________
Are you a veteran?
❏ Yes ❏ No
If yes, date of entry _________________________
Date of discharge __________________________
Type of separation or discharge (please enclose a
copy of your DD214 Form)
If you are not separated from the service, please provide
us with a letter from your commanding officer certifying
your current dates of active service and that you are in
good standing.
Parent or guardian‘s full name
Address (if different from above)
City/State/Zip
E-mail address
Occupation and location of employment
Veteran? ❏ Yes ❏ No
What is the highest degree obtained by this parent?
❏ High school diploma
❏ Associate’s (2-year) degree
❏ Bachelor’s (4-year) degree
❏ Master’s degree or higher
Parent or guardian‘s full name
Address (if different from above)
City/State/Zip
E-mail address
Occupation and location of employment
Veteran? ❏ Yes ❏ No
What is the highest degree obtained by this parent?
❏ High school diploma
❏ Associate’s (2-year) degree
❏ Bachelor’s (4-year) degree
❏ Master’s degree or higher
$50 Application Fee
The application fee will be waived if you meet one
or more of the following conditions. Check all that
apply.
❏ I am a current KSC student
❏ I graduated from KSC
❏ I am a professional educator
My KSC student ID# is _________________
Payment Method
❏ Visa
❏ MasterCard
❏ Check or Money Order
Credit card # Exp. Date
Signature
Name (no nicknames please) Last First Middle Former last name, if any
Permanent address, number and street
City /State /Zip Telephone, with area code
Mailing address, if different
City /State /Zip Telephone, with area code
E-mail address
* Students who fail to supply the correct Social Security number are not eligible to apply for financial aid or
to access their confidential application records through our online system, WebAdvisor.
Application for Graduate Study in Education
Wisdom to make a difference.
Graduate Admissions | Keene State College
229 Main Street | Keene, NH 03435-2605
Phone: 603-358-2497 | Fax: 603-358-2569
gradstudies@keene.edu | keene.edu/gradstudies/
click to sign
signature
click to edit
FOR ALL APPLICANTS
How did you learn about the Programs for Graduate Study in Education at Keene State College? ____________________________________________________
Are you currently certified by a state department of education as a teacher or education professional? If yes, list the state(s) and certification subject(s) or area(s):
State Certification(s) Number of Years
_____________ ___________________________________________________ ____________________________________
_____________ ___________________________________________________ ____________________________________
_____________ ___________________________________________________ ____________________________________
Have you been employed as a full-time teacher or education professional? ❏ Yes ❏ No
If yes, was the setting ❏ public ❏ private or ❏ other __________________________________________ ? For how many years?_____________
Disciplinary History
A. Have you ever been found responsible for a disciplinary violation (related to academic or behavioral misconduct) at an educational institution you attended
after high school (or the equivalent) that resulted in your probation, suspension, removal, dismissal, or expulsion? ❏ Yes ❏ No
B. Have you ever been convicted of a misdemeanor, felony, or other crime? ❏ Yes ❏ No
If you answered Yes to either or both questions, please attach a separate sheet of paper and provide approximate dates and an explanation of each incident.
If your situation changes after you apply, it is your responsibility to notify the Graduate Studies Office.
EDUCATION
List all undergraduate and graduate colleges and universities at which you have taken courses for credit. Submit official transcripts from each institution in order
to complete your application.
College/University Name Location Degree Candidate? Dates Attended Degree(s) Earned
(City, State/Province, Zip/Postal Code, Country) Yes No (mm/yyyy) # cr
___________________________ ___________________________________________________ ❏ ❏ ________________ ___________________ ______
___________________________ ___________________________________________________ ❏ ❏ ________________ ___________________ ______
___________________________ ___________________________________________________ ❏ ❏ ________________ ___________________ ______
___________________________ ___________________________________________________ ❏ ❏ ________________ ___________________ ______
___________________________ ___________________________________________________ ❏ ❏ ________________ ___________________ ______
EMPLOYMENT
Please list your most recent employment experiences.
Job Title and Nature of Work Employer Full- Part- Approximate Dates
Time Time (mm/yyyy–mm/yyyy)
___________________________________________________ ___________________________________________________________ ❏ ❏ ______________________________
___________________________________________________ ___________________________________________________________ ❏ ❏ ______________________________
___________________________________________________ ___________________________________________________________ ❏ ❏ ______________________________
___________________________________________________ ___________________________________________________________ ❏ ❏ ______________________________
REFERENCES
List the individuals who will be submitting letters of recommendation. Three are required; additional ones are optional.
Name Title Relationship to applicant (supervisor, associate, etc.)
Work address Telephone number
Name Title Relationship to applicant (supervisor, associate, etc.)
Work address Telephone number
Name Title Relationship to applicant (supervisor, associate, etc.)
Work address Telephone number
ii
Application for Graduate Study in Education
Wisdom to make a difference.
REQUIRED ESSAY DIRECTIONS
Prospective students must submit an essay of approximately three typewritten, double-spaced pages, with full name and page number in
the upper right-hand corner of each page. The essay will be reviewed by the Admissions Committee to evaluate your potential to effectively
engage in advanced studies and your ability to think and write clearly, creatively, and critically. Essays will be evaluated on form and content.
The Keene State College graduate program is committed to promoting school reform that embraces the needs of all students. For this
reason, we ask you to address each of the following points:
• Your experience with children of pre-kindergarten age through 12th grade. Please provide specific examples of your experience in
developing relationships and collaborating with youth, teachers, administrators, and families.
• Special abilities, life experiences, and personal qualities you bring to the program.
• Self-assessment: areas of strength in your knowledge and skills and areas for further development.
• Underlying values that guide you in working with and advocating for students in schools.
• Your experiences, thoughts, and feelings about working with people who are different from you.
• Your experiences as an advocate and/or agent of change within a system.
PROGRAM SELECTION (check appropriate box)
Please review the specific program information at keene.edu/gradstudies/ before selecting your program.
CURRICULUM & INSTRUCTION
Master of Education Degree: Curriculum and Instruction
❏ 1A Professional Development - 2 year part-time
❏ 1B Transfer 12 to 24 Articulation Agreement credits - 1 year part-time
❏ 1C New Teacher As Leader - 1 year full-time intensive
EDUCATIONAL LEADERSHIP
❏ 2 Master of Education Degree: Educational Leadership (grades K to 12)
❏ 3 Post-Master’s Certification: Educational Leadership (grades K to 12)
SCHOOL COUNSELOR
❏ 4 Master of Education Degree: School Counselor (grades K to 12)
❏ 5 Post-Master’s Certification: School Counselor (grades K to 12)
SPECIAL EDUCATION
Master of Education Degree: Special Education (grades K to 12)
❏ 6A M.Ed. with Certification - complete in 1 or 2 years
❏ 6B M.Ed. Only - Transfer 12 to 26 Articulation Agreement credits - 1 year part-time
Graduate Educator Certification: Special Education (grades K to 12)
❏ 6C Certification Only, non-degree - 1 year
POST-BACCALAUREATE TEACHER CERTIFICATION (this is a non-degree-bearing program consisting of undergraduate courses)
❏ 7 Biology (grades 7 to 12)
❏ 8 Chemistry (grades 7 to 12)
❏ 9 Dance (grades K to 12) available in conjunction
with Early Childhood or Elementary Education
❏ 10 Early Childhood Education (grades N to 3)
❏ 11 Earth/Space Science (grades 7 to 12)
❏ 12 Elementary Education (grades K to 8)
❏ 13 English (grades (5 to 12)
❏ 14 French (grades K to 12)
iii
Application for Graduate Study in Education
Wisdom to make a difference.
❏ 15 General Science (grades 5 to 9)
❏ 16 Mid./Jr. High Math (grades 5 to 8)
❏ 17 Music Education (grades K to 12)
❏ 18 Physical Education (grades K to 12)
❏ 19 Physics (grades 7 to 12)
❏ 20 Secondary Math (grades 7 to 12)
❏ 21 Social Studies (grades 5 to 12)
❏ 22 Spanish (grades K to 12)
FOR ALL APPLICANTS
I certify that I am aware of New Hampshire Law RSA 189: 13-A, which, in part, requires school administrative units to conduct a background
investigation and a criminal history records check for all individuals who, during the performance of their intended duties, would come into
regular contact with pupils. I understand that individuals who have been convicted of certain crimes are not allowed to work in an educational
setting. I further certify that to the best of my knowledge the information I have given in this application is correct and complete.
I understand that the College charges and bills for the entire semester. Checking this box is required and represents, upon registration, a firm
commitment to pay in full the total charges for the entire semester. This commitment becomes legally binding once I register for and begin
each semester.
NOTE: Applications will not be processed without a signature.
Today’s date Signature of applicant
The information provided to Keene State College becomes the property of the College. In accordance with the Family Educational Rights and
Privacy Act (FERPA), students retain the right to review their records.
WHEN COMPLETED
Return the completed application with requested materials to:
Graduate Admissions, Keene State College
229 Main Street, Keene, NH 03435-2605
Student‘s name
Last First Middle
Legal domicile New Hampshire
Street City
I have been legally domiciled at the address above for the past 12 months. I have no other domicile, am on the checklist of the town
or city of domicile, and am financially independent.
SIGNATURE OF APPLICANT
Sworn to me this day of , 20
(notary public, justice of the peace, etc.) (SEAL)
You must complete and have notarized the
statement below regarding domicile. If this is
not appropriate, attach a notarized statement
detailing all facts upon which your claim for
New Hampshire domicile is based. If you are
claiming New Hampshire domicile but are not
currently living in the state, be certain to explain
the circumstances that require you to live
elsewhere. Payment of property and/or
residency taxes does not in itself constitute
the basis for a claim to legal domicile.
New Hampshire residents who are military
personnel on assignment outside the state and
who are applying for admission or have depen-
dents doing so, should submit a statement
establishing that they entered the armed forces
from the state of New Hampshire. This statement
should be certified by a commanding officer.
A copy of “Rules Governing Tuition Rates for
the University System of New Hampshire” may
be obtained by writing the Admissions Office.
Misrepresentation of facts in order to establish
a claim to New Hampshire domicile will be
viewed by the Admission Office as justification
for revoking an acceptance or returning an
application without consideration.
NEW HAMPSHIRE RESIDENTS ONLY
iv
5/14
Application for Graduate Study in Education
Wisdom to make a difference.
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