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SupplementalApplication2017 Supplemental Application 2017

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MSW Supplemental Application
PERSONAL INFORMATION
Last Name: First Name: Middle:
Other name under which information can be found:
Address: City: State: Zip:
Cell Phone: Home Phone:
Email: Date of Birth:
Gender:
Ethnicity:
PROGRAM OF STUDY
Select one of the following programs for which you wish to apply. Please visit our website for more details
on programs, entry dates, program length, and start times.
Full-time Baton Rouge campus (begins fall only)
Part-time Baton Rouge campus (begins fall only)
Advanced Standing Baton Rouge campus (begins summer only)
MSW Online Full or part time (6 start dates per year) Entry Module:____________________
Advanced Standing (1-2 start dates per year) Entry Module:________________
Application to the School of Social Work:
If this is not your first application, when was the date of application:
Transferring from another CSWE accredited MSW program?
If yes, please list the university
Transcripts from this university must be evaluated for appropriate transfer credit prior to application to
insure equivalency
RECOMMENDATIONS
A total of three (3) recommendation forms with the required letter of support from each of your
recommenders are required for your admission file to be complete. Two (2) recommendations must be
Academic (college instructors, internship supervisors) and the remaining one (1) recommendation must
be a Professional (Work/Volunteer) Reference. Family friends, clergy, therapist and high school teachers
are not appropriate. Applicants who have been out of school for 2 or more years and cannot ascertain
academic references may substitute other professional recommendations for academic. For any
applicant, if two are not academic recommendations and one is not professional, please include a
statement and email this to sw@lsu.edu with your application explaining the reason for the substitution. It
is strongly recommended that if an internship was part of the degree program and the internship has been
completed at the time of application, a recommendation from the internship supervisor be included as the
professional recommendation. Complete your name, recommendation type and the access information
below. Send this form to your recommender and follow up to make sure it is completed and sent to the
School of Social Work by the deadline date.
1 Academic
2 Academic
3 Professional (work/volunteer)
PREREQUISITE
Female
Caucasian
1st Application
No
Completion of any introductory statistics course with a C or better is required PRIOR to entry. No waivers.
Please note, research based courses will not suffice for statistics.
Yes, completed
(Semester/Year) (Course Title and Number) (University)
No, currently enrolled
(Semester/Year) (Course Title and Number) (University)
No. Enrolling
(Semester/Year) (Course Title and Number) (University)
EDUCATION
Undergraduate Institutions Attended (list most recent first)
Name of Institution Major Date/Expected Date of Degree
Graduate Institutions Attended (list most recent first)
Name of Institution Major Date/Expected Date of Degree
EMPLOYMENT, VOLUNTEER AND INTERNSHIP EXPERIENCES
Your resume should reflect your work experience, volunteer experience and any internship experience (if
applicable). Please include your position, duties, start/end dates, and hours/wk. Resumes can be
uploaded to the Graduate School online application or emailed in pdf format to sw@lsu.edu.
LICENSURE & CREDENTIALS
Are you currently or have you ever been credentialed by a social work regulatory board in your state?
If yes, please attach a copy of your license to this application.
Have you ever had a disciplinary action imposed by ANY state regulatory board in your state?
If yes, please provide a copy of the consent order or disciplinary action taken.
CERTIFICATION
I certify that to the best of my knowledge, the information provided is correct and complete. I understand
that if it is later found to be otherwise, my application will be invalid or in the event that I am enrolled, I will
be subject to dismissal from the University. Furthermore, I understand that I must apply to the LSU
Graduate School by the deadline date corresponding to the MSW program for which I want to enroll
Typing is legally equivalent to your signature and constitutes your certification that the information
provided is accurate to the best of your knowledge.
Signature Date
No
No
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SupplementalApplication2017 Supplemental Application 2017

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Completed 6 May 2020

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