Graduate On-line Application Form
Office of Graduate Admissions
263 Alden Street Springfield, MA 01109-3797
1. Name:
Last Name:
First Name:
Middle Initial:
Date:
11/21/2009
2. Home Address:
Street:
City/Town:
State:
Choose one
AK
AL
APO-AA
APO-AE
APO-AP
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zip Code:
Telephone:
Home
:
School or Business:
Fax:
E-Mail:
Present Address (to which correspondence is to be sent):
Street:
City/Town:
State:
Zip Code:
Choose one
AK
AL
APO-AA
APO-AE
APO-AP
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
3. U.S. Citizen:
Yes
No
Permanent Resident:
Yes
No
Social Security Number:
If not U.S. citizen, please indicate country of present citizenship:
4. Gender:
Male
Female
Please indicate any other last names used:
5. Date of Birth:
6. Colleges and universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions:
Do you consider yourself to be Hispanic/Latino?
Yes
No
In addition, select one or more of the following racial categories to describe yourself:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
7. Please indicate whether you wish to receive Springfield College housing information:
Yes
No
8. What most influenced your application for admission? Please check only one.
Choose one
Alumnus
Campus Visit
Counselor/Faculty Advisor
Current Student
Graduate School Publication
Other
Reputation of Program
9. Intended Date of Entry:
10. Please indicate your choice of degree, academic area of study, and, if appropriate, your intended program/concentration*:
program list updated: 07/13/2009
Master's Degree
Master's Program:
Choose One
*Art Therapy
Business Administration
*Education
Education--Evening Graduate Program
*Exercise Science & Sport Studies
Health Studies
*Occupational Therapy
*Occupational Therapy--Evening Graduate Program
*Physical Education
Physical Education--Evening Graduate Program
Physician Assistant
*Psychology & Counseling
Psychology & Counseling--Evening Graduate Program
*Rehabilitiation Counseling & Services
Rehabilitation Counseling and Services--Evening Graduate Program
*Social Work
*Sport Management & Recreation
*REQUIRED - Select your intended program/concentration within the area of study checked above
:
Master's Concentration
Choose One
ART THERAPY/Clinical Art Therapy
BUSINESS ADMINISTRATION/Management
BUSINESS ADMINISTRATION/Nonprofit Management
EDUCATION/Educational Studies
EDUCATION/Educational Studies-Early Childhood Education
EDUCATION/Educational Studies-Elementary Education
EDUCATION/Educational Studies-Secondary Education
EDUCATION/Educational Studies-Students with Moderate Disabilities
EXERCISE SCIENCE AND SPORT STUDIES/Athletic Training
EXERCISE SCIENCE AND SPORT STUDIES/Exercise Physiology
EXERCISE SCIENCE AND SPORT STUDIES/Health Promotion and Disease Prevention
EXERCISE SCIENCE AND SPORT STUDIES/Sport Psychology
EXERCISE SCIENCE AND SPORT STUDIES/Strength and Conditioning
HEALTH STUDIES/Health Education Teacher Licensure
OCCUPATIONAL THERAPY – Entry Level Masters
OCCUPATIONAL THERAPY – Post Professional Program
PHYSICAL EDUCATION/Adapted Physical Education
PHYSICAL EDUCATION/Advanced Level coaching
PHYSICAL EDUCATION/Athletic Administration
PHYSICAL EDUCATION/Physical Education Teacher Licensure
PHYSICAL EDUCATION/Physical Education Teaching-Clinical
PSYCHOLOGY AND COUNSELING/Athletic Counseling
PSYCHOLOGY AND COUNSELING/Industrial/Organizational Psychology
PSYCHOLOGY AND COUNSELING/Marriage and Family Therapy
PSYCHOLOGY AND COUNSELING/Mental Health Counseling
PSYCHOLOGY AND COUNSELING/School Counseling and Guidance
PSYCHOLOGY AND COUNSELING/Student Personnel Administration
REHABILITATION COUNSELING AND SERVICES/Alcohol and Substance Abuse Counseling
REHABILITATION COUNSELING AND SERVICES/General Rehabilitation Counseling
REHABILITATION COUNSELING AND SERVICES/Psychiatric Rehab & Substance Abuse Counseling
REHABILITATION COUNSELING AND SERVICES/Pediatric Developmental Disabilities
REHABILITATION COUNSELING AND SERVICES/Special Services-Disability Studies
SPORT MANAGEMENT AND RECREATION/Recreation Management
SPORT MANAGEMENT AND RECREATION/Sport Management
SPORT MANAGEMENT AND RECREATION/Therapeutic Recreation Management
SPORT MANAGEMENT AND RECREATION/Therapeutic Recreation Management/Child-Life Specialist Track
SOCIAL WORK/Advanced Standing-Weekday
SOCIAL WORK/Advanced Standing-Weekend
SOCIAL WORK/Combined MSW/JD Program - "Weekdays Only"
SOCIAL WORK/Regular Weekday Program
SOCIAL WORK/Regular Weekend Program
concentration list updated: 11/25/2008
Certificate of Advanced Graduate Study (CAGS)
Certificate of Advanced Graduate Study Program:
Choose One
Art Therapy
Education
Occupational Therapy
Physical Education
Psychology and Counseling
Rehabilitation Counseling and Services
*Indicate your intended program/concentration within area of study checked above:
Certificate of Advanced Graduate Study
Choose One
ART THERAPY/Clinical Art Therapy
EDUCATION/Education Administration
EDUCATION/Educational Studies
EDUCATION/Educational Studies-Early Childhood Education
EDUCATION/Educational Studies-Elementary Education
EDUCATION/Educational Studies-Secondary Education
EDUCATION/Educational Studies-Students with Moderate Disabilities
HEALTH STUDIES/Health Education Teacher Licensure
PHYSICAL EDUCATION/Physical Education Teacher Licensure
PHYSICAL EDUCATION/Physical Education Teaching-Clinical
PSYCHOLOGY AND COUNSELING/Athletic Counseling
PSYCHOLOGY AND COUNSELING/Industrial/Organizational Psychology
PSYCHOLOGY AND COUNSELING/Marriage and Family Therapy
PSYCHOLOGY AND COUNSELING/Mental Health Counseling
PSYCHOLOGY AND COUNSELING/School Counseling and Guidance
PSYCHOLOGY AND COUNSELING/Student Personnel Administration
REHABILITATION COUNSELING AND SERVICES/General Rehabilitation Counseling
REHABILITATION COUNSELING AND SERVICES/Special Services-Disability Studies
REHABILITATION COUNSELING AND SERVICES/Substance Abuse Counseling
REHABILITATION COUNSELING AND SERVICES/Psychiatric Rehab & Substance Abuse Counseling
REHABILITATION COUNSELING AND SERVICES/Pediatric Developmental Disabilities
Doctor of Physical Education
Doctor of Physical Therapy
Doctoral Programs:
Choose One
EXCERCISE SCIENCE AND SPORT STUDIES/Exercise Physiology
EXCERCISE SCIENCE AND SPORT STUDIES/Sport and Exercise Psychology
PHYSICAL EDUCATION/with a Specialization in Teaching & Administration
PHYSICAL THERAPY
11. Undergraduate College or University:
Graduation Date:
Major Field:
Degree:
12. Graduate College or University:
Graduation Date:
Major Field:
Degree:
13. Please list other collegiate institutions attended and dates of attendance:
College#1:
Date:
College#2:
Date:
College#3:
Date:
College#4:
Date:
College#5:
Date:
College#6:
Date:
14. Please select three people who can comment on your interest in graduate study at Springfield College and your ability, potential, and readiness for the graduate program you have selected. We suggest you seek references from faculty members, advisors, internship supervisors, current or past employers, colleagues, or alumni of Springfield College. Social Work applicants should submit professional supervisors' or academic references only. (Note: If you are currently enrolled in a master's degree at Springfield College, only two references from faculty with whom you took classes at Springfield will be needed.)
Name:
Relationship to Applicant:
#1
#1
#2
#2
#3
#3