Graduate Form
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B O R I C U A A C O L L E G E P P L I C A T Graduate Admissions I Manhattan Campus Bronx Campus Center Brooklyn Campus Center 3755 Broadway 890 Washington Avenue 9 Graham Ave New York, NY 10032 Bronx, NY 10451 Brooklyn, NY 11206 212-694-1000 347-964-8600 718-963-4112 O [email protected] [email protected] [email protected] Boricua College is accredited by the Middle States Commission on Higher Education N PERSONAL INFORMATION: Legal Name: __________________________________________________________ Last (Family Name) First (Given Name) Middle Name Maiden Name: _______________________________________________________________ (If Applicable) Gender: Male Female Date of Birth: ___ / ___ / ___ Address: ___________________________________________________________________ Street Name Apt. Number ____________________________________________________________________ City State Zip Code Country Cell Phone: ____ - ____ - ____ Alternate Phone: ____ - ____ - ____ Email Address: ______________________________________________________________ ENROLLMENT INFORMATION: APPLYING AS: Transfer Re-Admit Continuing I am interested in: MASTER DEGREE Human Services Education-TESOL Latin American & Caribbean Studies INTENDED MAJOR: I will register for: Fall of 20__ (Sept.) Spring of 20__ (Jan.) Time: Evening Campus/Location of Choice: Manhattan Bronx Brooklyn EDUCATIONAL INFORMATION: What will be your academic status at the time of enrollment? I have earned a degree from Boricua College I have earned a degree from another college or university Please list below all the college(s) you have attended: School Name Dates Attended _______________________________________ ______________________ _______________________________________ ______________________ College Graduation Date: ________________ Degree Earned: _________________________ Major: _______________ DEMOGRAPHIC INFORMATION: Marital Status: Single Separated/ Divorced Date: ___________ Married Date: _________ Widowed Date: ___________ Immigration Status: U.S Citizen U.S Permanent Resident F-1 Student Status Place of Birth: ______________________ Ethnicity: Hispanic/Puerto Rican Hispanic/Dominican Hispanic/Other African American Asian White Other Primary Language: __________________ Country of Origin: _________________ Emergency Contact: ____________________________________________________ Name Relationship to Student Phone Number Military Service? No Yes If yes, please provide DD214/Military Separation Form Medical Conditions? No Yes If yes, explain condition below: _____________________________________________________________________________________ _____________________________________________________________________________________ Are you disabled? No Yes _ If yes, please describe below and provide documentation. _ _ _ ____________________________________________________________________________ __________ _ ______________________________________________________________________________________ _ _ _ Disciplinary Questions:_ _ Have you ever been suspended_ , removed, dismissed or expelled from any school or academic institution? _ _ No Yes _ If yes, please explain why _____________________________ _ _ _ ___________________________________________________________________________ _ _ _ _ _ _ _ _ _ Have you_ ever been _convicted_ of any felony, misdemeanor or other crime? (Omit traffic _ offenses)_ _ _ _ _ _ _ No Yes_ If yes, please describe offense and date of offense below: __ _ _ _ ________________________________________________________________________ _ _ _ _____________ __ _ _ _ _____________________________________________________________________________________ _ _ _ __ _ _ _ ___________________________________________________________________________________ __ _ _ _ _ _ _ NOTE_: Answering yes_ to either of the two questions does not automatically bar you from __ _ _ _ admission to Boricua College __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ REFERRAL INFORMATION: How did you hear about Boricua College? Current Boricua College Student Direct Mail _ _ Friend/Family Member Open House/College Fair _ _ _ _ _ _ Co-worker Newspaper/Other Advertisement _ _ _ _ _ _ _ _ _ _ Employer Guidance or College Counselor _ _ _ _ _ _ _ _ _ _ _ _ _ Boricua Alumni Association Flyer/Tabling _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Online _ Walk-in _ _ _ _ _ _ _ _ _ _ _ _ What_ are the most important reasons for choosing to_ attend Boricua College? (check all _ _ that _apply) _ _ _ _ _ _ _ _ Academic Major _ Small Class Size Colloquium _ _ _ _ _ Career Advancement _ Individualized Instruction _ _ _ _ _ _ _ Convenient Location _ Recommended by Friend/Family _ _ _ _ _ Academic Reputation _ Personal Growth _ _ _ _ _ _ _ Faculty – Education Facilitators _ Educational Model _ _ _ _ _ _ _ _ _ _ _ _ _ _ PERSONAL_ ESSAY GUIDELINES _ _ _ _ _ _ _ Please_ answer the following questions (350 words minimum)._ You must type your _ _ response_ and be sure to include relevant details. _ _ _ _ _ _ _ 1)_ Why are you pursuing a master’s degree (in TESOL_ or Human Services) with _ _ _ _ _ Boricua College? _ _ _ _ _ _ _ 2)_ What are the most critical issues in your field _today? _ _ _ _ _ _ 3)_ Describe how your professional life influenced_ your decision to attend graduate _ _ _ school. _ _ _ _ _ _ _ _ _ _ _ _ _ Please_ sign and date your essay. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ EDUCATIONAL STATEMENT (Please read and sign) I understand that Boricua College reserves the right to refuse admission and matriculation to any applicant who, in the College’s judgment is not qualifies. Boricua College reserves the right to require withdrawal of any student, at any time, for any reason deemed sufficient under the rules and traditional practices of the College. _______________________________________________ _________________________ Signature of Applicant Date of Application APPLICATION CHECKLIST Completed Application (The application cannot be processed if questions are left unanswered) M a 350 Word Personal Essay (Typed) n h A $100.00 non-refundable fee is required to process this application a (money orders only) t t College Degree (Bachelors) a n Official College Transcript (If foreign degree, must be translated by GLOBE or WES) C a Valid Government Issue ID m p Social Security Card and/or Alien Registration Card (If applicable) u s Admissions Interview B Proof of Income r o Immunization Record (Measles, Mumps and Rubella) n x Meningitis Response Form Completed C Resume and Cover Letter a m Please mail your application or drop it off in person to the location of your choice:p u Manhattan Campus Bronx Campus Center Brooklyn Campus Center s 3755 Broadway 890 Washington Avenue 9 Graham Ave New York, NY 10032 Bronx, NY 10451 Brooklyn, NY 11206 C 212-694-1000 347-964-8600 718-963-4112 [email protected] [email protected] [email protected] n t e r B Admissions Interview Interview Date ___ / ___ / ___ Faculty Recommendation No Yes _ _ Faculty Signature: ______________________________________________________ _ _ _ Results: _ _ _ _ English Oral High Medium Low _ _ _ _ _ _ _ Conceptual _ High _ Medium _ Low _ _ _ _ _ Affective High Medium _Low _ _ _ _ _ _ _ _ _ Clarity of Values High Medium _Low _ _ _ _ _ _ _ _ _ _ _ _ Comments: ________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ __________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ ___________________________ __________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________________________________________________ _ _________________________ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____________________________________________________________________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Recruiter: ______________________________________ _ _____ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.