Submission Deadline 1/15/2016
Master of Social Work Program
Application for Admission PART I
Page 1 of 3
Today’s Date: ________________ dd/mm/yyyy
Program ID
(For Office Use)
Background Information
First Name ____________________________ M.I. ________ Last Name ___________________________________
Address _________________________________________________________________________________________
City/Town ________________________________________ State _______________ ZIP code ________________
Daytime Phone:
Evening Phone:
Email address ___________________________________________________________________________________
Choose
Gender _______________
Date of Birth _____________________ (mm/dd/yyyy)
Choose one
Race/Ethnicity ________________________________________
If other __________________________________
Plan of Study
Please check the Plan of Study you expect to complete.
There are two MSW Program offerings, the Advanced Standing Program and the Full MSW Program.
If you have earned a BSW degree from a CSWE accredited Program you may apply for the Advanced Standing
Program (32 Credit Hours). If you have not earned a BSW Degree you must apply to the Full MSW Program
(60 Credit Hours).
If you are applying to the Advanced Standing Program,
select one of the following study options:
Choose one
____________________________________
If you are applying to the Full Program MSW Program,
select one of the following study options:
Choose one
____________________________________
Choose one
Please choose the MSW Concentration or area of specialization you will pursue: ____________________________
Will you require financial assistance to complete your plan of study?
If yes please check all that apply:
Choose one
______________
Educational Loans
Federal Funds
Are you applying for admission to M.S.W. programs at other institutions?
Application Deadline
Advanced Standing - March 1
Full MSW Program - March 15
Scholarship
Employer Tuition
Reimbursement
Choose one
Master of Social Work Program
Application for Admission
Page 2 of 3
Your Computer Experience and Skills
Do you own a personal computer?
Choose one
Do you have access to high-speed internet?
Choose one
Do you have word processing capability?
Choose one
Do you have presentation software
Choose one
How would you rate your level of skill in using computer
software such as word processing and presentation software? Skill Level
Please indicate any additional educational support you will require to successfully complete your study plan.
Educational Background
Baccalaureate Education
Graduate Education (if applicable)
_____________________________________
Baccalaureate Institution
____________________________________
Graduate Institution
_______________________
Major
_______________________
Discipline/Profession
___________
Year Degree Granted
___________
Year Degree Granted
If undergraduate major is social work, are you applying for admission to the
Advanced Standing Degree Program? ___________
Choose one
Advanced Standing Degree seeking students must have completed an accredited BSW within 7 years of the date of
admission to the M.S.W. program, and must have a 3.0 GPA in the social work major. Credit for Life Experience is
not offered.
Choose one
Are you requesting transfer credit? ____________
Transfer Coursework**
Number & Name of Course
Name 0f Institution
** Transcript(s) Required.
Application Deadline
Advanced Standing - March 1
Full MSW Program - March 15
Year Completed
Master of Social Work Program
Application for Admission
Page 3 of 3
Additional Background Information:
Your response to the following questions will not affect your eligibility for admission to our program. These
questions are designed to gather pertinent information to inform your plan of study if you are admitted to the
MSW Program.
one
_________
Have you ever been convicted of a felony? Choose
If yes do you think your conviction or anything in your background will create barriers to a quality Field Internship
one
in a social work agency? Choose
_________
Please explain: ____________________________________________________
In which area (s) of Social Work are you planning to practice?
Check all that apply:
Practice with Children, Adolescents and
Aging/Gerontological Social Work
Alcohol, Drug, or Substance Abuse
Families
School Social Work Practice
Community Organization/Planning
Leadership and Management
Developmental Disabilities
Health Services
Mental Health or Community
Social Work Administration
Corrections Criminal Justice
Housing Services
International Social Work
Program Evaulation
Social Policy
Social/Public Welfare
Occupational
Other
Rehabilitation
specify:
Veteran Status
Choose one:
Application Deadline
Advanced Standing - March 1
Full MSW Program - March 15