<p> 1</p><p>Application Form Counselor Education Program, NC State University</p><p>Instructions: Please feel free to insert additional pages such as your resume, as needed. Completed forms and other documents should be uploaded to the Graduate School online admissions (under “Other Document”). The Graduate School requires a separate online application. Application deadline is Dec 1 for online masters program for spring, 2016, and Dec 1 for doctoral program, and Jan 15 for masters program for summer/fall, 2016.</p><p>I. Personal Data</p><p>Proposed entrance date______Date of Application______Semester Name______Last (Family) First Middle or Maiden</p><p>Gender: ______Ethnicity: ______</p><p>Telephone Number______email: ______</p><p>Present address______</p><p>Permanent Address______</p><p>State of legal residence ______Country of citizenship______</p><p>II. Graduate Major (indicate your preference for online and on-campus): Examples:</p><p>College Counseling 2nd_ on campus 1st_ online (i.e. this is first choice) or College Counseling 1st on-campus ___ online (leave the online blank to indicate not considering the online program)</p><p>Masters Degree Track M.Ed. M.S. (3-year program with thesis) (only for on-campus program)___</p><p>School Counseling ___on-campus ___online ____</p><p>College Counseling & Student Development ___on-campus ___online ____</p><p>Clinical Counseling ___on-campus ___ online_ ____</p><p>Doctoral Program 2</p><p>(Counseling & Counselor Education ) ____(on-campus only, put a check mark) Doctoral Students</p><p>In addition to the application material, you will be required to (1) have an interview and (2) complete work-sample materials. This requirement may be waived, if geographical distances are substantial.</p><p>We will call you to set up a mutually convenient time. You will need to set aside approximately 2 hours for the interview and work sample.</p><p>III. Education Degree granted Colleges and graduate schools Dates attended or pending (list all attended) From To Major and date</p><p>List any honors, awards, fellowships, or scholastic distinctions you received in college and/or graduate school.</p><p>To what other graduate schools are you applying at this time? (Include other majors or departments at NCSU as well.)</p><p>If you have spoken to or corresponded with a member(s) of the NCSU faculty regarding your application, please give those name(s).</p><p>How did you learn about our graduate program?</p><p>What articles, significant term papers, theses, or reports of experimental investigations have you written? List their titles below. (If you wish, you may submit such materials in support of your application, under “Other Documents” in the online admissions)</p><p>Are you certified to teach? If so, in which subjects and states? 3</p><p>IV. Financial Aid Information</p><p>Please describe your plans for financing your graduate studies, indicating any unusual circumstances in your case which should be brought to the attention of the review committee.</p><p>Would you accept an offer of admission if no financial aid were available?</p><p>____ Would not accept ______Would accept</p><p>If you have discussed financial assistance with any member of the NCSU faculty, please give that individual's name.</p><p>______Check this space if you do not wish to be considered for financial support. If you do want to be considered, please rank (with a "1" indicating your top choice) your preferences for the types of financial assistance listed below. If you would like to be considered for other types of aid, please list them under the "Other" category.</p><p>Rank Type ____ Administrative assistantship ____ Research assistantship __ _ Teaching assistantship ____ Fellowship or traineeship ____ Special university funds for minority students</p><p>North Carolina State University is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, creed, color, sex, national origin, or disabilities.</p><p>***You may attach your resume here by starting a new page. After you complete everything, save it and upload it to online application under “Other Documents.”</p>