1
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.Please adhere to application due dates posted on the website.
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 (indicate your preference for online and on-campus): Examples:
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)
Masters Degree Track M.Ed.
SchoolCounseling ___on-campus ___online
College Counseling
& Student Development ___on-campus ___online
Clinical Counseling ___on-campus ___ online_
Doctoral Program
(Counseling & Counselor Education )____(on-campus only, put a check mark)
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
If you have discussed financial assistance with any member of the NCSU faculty, please
give that individual's name.
______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 the online application under “Other Documents.”