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Application Form

Counselor Education Program, NC State University

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 December 1 for doctoral program, and January15 for masters on-campus option program; 12/15 (priority deadline) for online option program, 4/15 regular deadline for online option program. All master’s program begins from Summer I (mid-May). Doctoral program begins from fall semester.

I. Personal Data

Proposed entrance date______Date of Application______

Semester

Name______

Last (Family) First Middle or Maiden

Gender: ______Ethnicity: ______

Telephone Number______email: ______

Present address______

Permanent Address______

State of legal residence ______Country of citizenship______

II. Graduate Major (mark one option only):

Master’s Programs

SchoolCounseling ___on-campus or___online

College Counseling

& Student Development ___on-campus or___online

Clinical Counseling ___on-campus or___ online

Doctoral Program

Counseling & Counselor Education____(on-campus only)

Doctoral Students

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 geographicaldistances are substantial.

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.

III. Education

Degree granted

Colleges and graduate schools Dates attended or pending

(list all attended)From ToMajorand date

List any honors, awards, fellowships, or scholastic distinctions you received in college

and/or graduate school.

To what other graduate schools are you applying at this time? (Include other majors or

departments at NCSU as well.)

If you have spoken to or corresponded with a member(s) of the NCSU faculty regarding yourapplication, please give those name(s).

How did you learn about our graduate program?

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)

Are you certified to teach? If so, in which subjects and states?

IV. Financial Aid Information

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.

Would you accept an offer of admission if no financial aid were available?

____ Would not accept ______Would accept

______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.

Rank Type

____ Administrative assistantship

____ Research assistantship

__ _Teaching assistantship

____ Fellowship or traineeship

____ Special university funds for minority students

V. Where did you first learn about our programs? (please select one from the following)

___ Internet search engine

___ NCSU website

___ NCSU College of Education Facebook

___ Counselor Education Admissions Information Session

___ Graduate School Career Fair

___ Friends/word of mouth

___ NCSU faculty (e.g. Psychology Department/classes)

___ Other places (please specify: ______)

***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.”