/ COLLEGE OF EDUCATION  DEPARTMENT OF TEACHER EDUCATION
M.A. in Teaching and Curriculum  301F Erickson Hall E. Lansing, MI48824-1034

APPLICATION FOR CHANGE OF PROGRAM AND STATUS

This is a WORD form. Please type directly into this form, save it on your computer, and submit it as an email

attachment or as a printed copy by regular mail at the address above or FAX to (517)-432-5092.

PLEASE NOTE: This application and all supporting documents become the property of MichiganStateUniversity and will not be returned to the applicant, forwarded to another institution, or duplicated for any purpose.

MSU PID: / MALE / FEMALE
LAST: / FIRST: / MIDDLE:
ADDRESS: / CITY: / STATE: / ZIP:
ETHNIC RACIAL GROUP (THIS DOES NOT APPLY TO FOREIGN STUDENTS AND IS OPTIONAL FOR ALL OTHER CANDIDATES)
1. White/Caucasian / 2.Black/Afro American / 3. Chicano/Mexican American / 4. Hispanic
5. American Indian / 6. Asian/Pacific Islander / 7. Other (please describe) `
THIS IS AN APPLICATION FOR: / Fall / Spring / Summer / Year:
DEGREE LOCATION: / Campus (program 6727) / Online MATC (program 6728)
LIST, IN CHRONOLOGICAL ORDER, ALL COLLEGES ATTENDED INCLUDING EVENING AND EXTENSION WORK
UP-TO-DATE-OFFICIAL TRANSCRIPTS OF ALL ACADEMIC WORK (EXCLUDING MSU) MUST BE SUBMITTED
Name of Institution / City / State / Attendance Dates
Month & Year
Date / Degree / Major
E-MAIL: / ARE YOU PRESENTLY ENROLLED? Yes No
DO YOU HAVE A TEACHING CERTIFICATE?: / Yes / No
TYPE OF TEACHING CERTIFICATE YOU HAVE: / Elementary / Secondary
Provisional / Continuing/Permanent

MichiganStateUniversity seeks to admit students who provide evidence of intellectual performance, good character, and potential which will permit them to profit from programs of the academic rigor of those offered by MichiganState. The University recognizes that learning opportunities are enhamced by a secure environment. As part of the admissions process, we require applicants to respond to the following questions. Information provided in response to these questions needs to be reviewed, but rarely results in denial of admission.

Yes Noa. Have you ever been expelled, suspended, disciplined, or placed on probation by a secondary school or

college you have attended because of (a) academic dishonesty, (b) financial impropriety, or (c) an offense

that harmed or had the potential to harm others?

Yes Nob. Have you ever been convicted of a criminal offense (including in juvenile court) other than a minor traffic

violation or are there criminal charges pending against you at this time?

If you answer yes to either of these questions, please submit a letter of explanation. If the circumstances arise in the future (until the time you begin attending classes) that make your answers to the above questions inaccurate, misleading, or incomplete, you must provide the Office of Admissions with updated information.

YOUR PRESENT STATUS:

COLLEGE: / GRADE POINT AVERAGE LAST HALF OF UNDERGRADUATE WORK:
STATUS: / TERM HOURS OF GRADUATE CREDIT EARNED TO DATE:
PROGRAM: / GRADE POINT AVERAGE, GRADUATE CREDITS EARNED TO DATE:
ADVISOR: / NUMBER OF GRADUATE CREDITS BELOW “3.0” (B)
THIS IS AN APPLICATION FORCHANGE OF PROGRAM TO: / (Specify Area of Emphasis)
CHANGE OF STATUS TO: / Masters / Specialist / Doctoral

STATEMENT OF PURPOSE: You must attach a separate page, (8 ½ x 11) stating your plans for graduate study and a professional

career. Please be specific.

------FOR OFFICE USE ONLY------

ACCEPTANCE REFUSED: (state reason)______

ACCEPTANCE APPROVED:  Non Degree  Masters  Specialist  Doctoral

 Regular  Provisional (requirements to be met) ______

______

PROGRAM COORDINATORDATENEW ADVISOROFFICE & PHONE