NEW STUDENT APPLICATION TEACHER EDUCATION PROGRAMS

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NEW STUDENT APPLICATION

TEACHER EDUCATION PROGRAMS

SUBMIT VIA MAIL, EMAIL, OR HAND DELIVERY.

Office of Admissions

Claremont Graduate University

160 E. 10

th

St.

Claremont, CA 91711

Email as a scanned PDF: [email protected]

Hand deliveries accepted at above address Mondays-Fridays from 8:30am-5:00pm.

Office of Admissions

For all application-related inquiries: (909) 621-8069 • [email protected]

Teacher Education Office

For all program-related inquiries: (909) 607-3692 • [email protected]

International Student Services

For all immigration-related inquiries: (909) 607-0434 • [email protected]

Print & handwrite

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CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM

APPLICATION FOR ADMISSION.

Preliminary Credential + MA Program Applicants

PRINT, COMPLETE & SUBMIT:

 The Core Application (pages 3–6)

 The Additional Forms for Preliminary Credential + MA Program (page 7)

 Financial Aid Application Form (page 10 )

 Optional Survey. (page 11) ALSO SUBMIT:

 Application Fee or Fee Waiver Form

 Statement of purpose/writing sample

 Current resume

 3 letters of recommendation

 Post-secondary transcripts. Unofficial can be submitted and then replaced with official/sealed transcripts.

 CBEST & CSET (and if applicable TOEFL or IELTS) scores and/or copies of registration forms.

*Induction/Clear Program Applicants

*Note: There is a different application process for people in CGU’s Preliminary Credential + MA Program who are taking the “Direct to Clear” Path.

 The Core Application (pages 3–6)

 The Additional Forms for the Induction/Clear Program (pages 8-9)

 Financial Aid Application Form (page 10)

 Optional Survey. (page 11) ALSO SUBMIT:

 Statement of purpose/writing sample. [N/A if you are a recent CGU Teacher Ed alumnus (within past 5 years.)]

 Current resume

 3 letters of recommendation (or if you are a recent CGU Teacher Education Alumnus, 2 statements of support)

 Post-secondary transcripts. Unofficial can be submitted and then replaced with official/sealed transcripts. [N/A if you are a recent CGU alumnus (within past 5 years.)]

Autism Certificate/Authorization Program Applicants

 The Core Application (pages 3–6).

 Financial Aid Application Form (pages 10).

 Optional Survey. (pages 11). ALSO SUBMIT:

 Statement of purpose/writing sample. [N/A if you are a recent CGU Teacher Ed alumnus (within past 5 years.)]

 Current resume

 3 letters of recommendation (or if you are a recent CGU Teacher Education Alumnus, 2 statements of support)

 Post-secondary transcripts. Unofficial can be submitted and then replaced with official/sealed transcripts. [N/A if you are a recent CGU alumnus (within past 5 years.)]

ADMISSIONS DEADLINES

Applications to CGU are accepted on a rolling basis; therefore, we welcome applications year-round. Priority dates

are established to give top consideration to those who apply by the specified dates.



July 1st is the priority deadline for candidates wanting to start a Teacher Education program in Fall/August.



November 1st is the priority deadline for candidates wanting to start a Teacher Education program in

Spring/January.



April 1st is the priority deadline for candidates wanting to start a Teacher Education program in

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CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM

APPLICATION FOR ADMISSION.

Core application for all Teacher Education Programs.

CLAREMONT COLLEGES AFFILIATION

I am a

 Current Student at…

 Alumnus of…

 Staff at…

 Faculty at…

 Dependent of Staff or Faculty member of CGU/Claremont Colleges who works at….

 Claremont McKenna  Harvey Mudd  Pitzer  Pomona  Scripps  KGI  CGU, Program______________________________________________ I am a 5Cs student/alumnus and have:

 taken EDUC 300G.

 taken EDUC 170G.

 taken other BA/MA classes approved for MA Electives for General Educators. _____________________________________ (name them)

APPLICATION FEE. Applicants are required to submit a $60 non-refundable application fee. Fee waived if the applicant is a

CGU/Claremont College student, alumnus, staff, or faculty or if there is financial hardship. Application Fee Waiver can be found at: www.cgu.edu/TeacherEducationAdmissionsInfo.

PERSONAL INFORMATION. Please print legibly.

Last/Family Name: _________________________________________________________________________________________________________ First/Given Name: ______________________________________________________Middle Name: ________________________________________ Former /Other Family Name:__________________________________________________________________________________________________ Former/Other First Name:____________________________________________________________________________________________________ U.S. Social Security #: ________--______--________ Sex: Female_____ Male _____ Birth Date:(MM/DD/YYYY )_______- _______- __________

Citizenship: ____ Visa Type:______________________

Birth Country: ____________________________________ City: _______________________________ State/Prov: ____________________________ Primary Email Address: _______________________________________ Secondary Email Address: ________________________________________ Home Phone: (_____) _____________________ Cell Phone: (_____ ) _____________________ Work Phone: (_____ ) _____________________ I have previously applied to CGU: No Yes, for this semester and year: __________________________________________________________

ADDRESSES. Please write your address line-by-line as it should appear on an envelope including the postal code and country. If your

address changes at any time during your application process, notify [email protected] so we can update your record.

Permanent Address (required) Mailing Address (if different) Good until: ______________ (Date)

_________________________________________________________ ___________________________________________________________ _________________________________________________________ ___________________________________________________________ _________________________________________________________ ___________________________________________________________ _________________________________________________________ ___________________________________________________________

CALIFORNIA CREDENTIAL VERIFICATION.

 I have a California Teaching Credential and have attached a copy. Additionally, I understand CGU will be verifying this information with the California Commission on Teacher Credentialing (CCTC). (Teachers can obtain a copy of their credential at

https://teachercred.ctc.ca.gov/teachers/PersonalSearchProxy.)

Signature: _________________________________________________________________ Date: __________________________

________________________

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CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM

APPLICATION FOR ADMISSION.

Core application for all Teacher Education Programs.

CGU Teacher Education Application; revised April 2012

page 4

TEACHER EDUCATION PROGRAM TO WHICH YOU SEEK ADMISSION.

 Preliminary Credential + Master Degree Program.

General Education Credentials + MA in Education

 Multiple-Subject Credential

 Single-Subject English / Language Arts

 Single-Subject Social Studies / History

 Single-Subject Spanish

 Single-Subject credential in Science  Physics

 Chemistry

 Biology / Life Science  Geo-Science

 Single-Subject Math  MA in Education

 MA in Applied Mathematics

Education Specialist Credentials + MA in Education  Mild/Moderate

 Moderate / Severe

 Dual Education Specialists Credential Program: Mild / Moderate + Moderate / Severe. I want to start with:

 Mild / Moderate  Moderate / Severe

 Expedited Education Specialist Credential (Mild / Moderate or Moderate / Severe) for General Educators (Multiple- or Single-Subject)

 Mild / Moderate  Moderate / Severe

Dual Education Specialist/General Education Credential + MA in Education

Education Specialist Credential:  Mild / Moderate  Moderate / Severe General Education Credential:

 Multiple-Subject Credential

 Single-Subject English / Language Arts

 Single-Subject Social Studies / History

 Single-Subject Spanish

 Single-Subject credential in Science  Physics

 Chemistry

 Biology / Life Science  Geo-Science

 Single-Subject Math

 Induction / Clear Program:

 Multiple Subject Clear Credential

 Single Subject Clear Credential

 Education Specialist Clear Credential

 Mild / Moderate

 Moderate / Severe

 Autism Certificate/Authorization:

 Autism Certificate. CGU’s Autism Certificate provides educators and community members with information that allows them to better interact with and serve students with Autism Spectrum Disorders (ASD). By law, teachers must have appropriate credentials/authorizations to work with students with ASD. For General Education teachers and non-credentialed personnel, this Certificate does not provide such legal authorization.

 Added Authorization in Autism. For

Mild/Moderate Education Specialists who earned their credential prior to 2012,the CGU’s Autism Certificate can be used to meet the state’s legal requirement for an “Added Authorization” in Autism.

WHEN DO YOU WANT TO START YOUR PROGRAM IN TEACHER EDUCATION?

Preliminary Credential + Master Degree Program  Spring / January ______________ Year

 Summer / May ______________ Year

 Fall / August ______________ Year (For General Education Candidates only.)

Induction/Clear Program

 Fall / August ______________ Year

 Spring / January ______________ Year

 Summer / May ______________ Year

Autism Authorization/Certificate

 Fall / August ______________ Year

 Spring / January ______________ Year

 Summer / May ______________ Year

________________________

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CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM

APPLICATION FOR ADMISSION.

Core application for all Teacher Education Programs.

LANGUAGE CAPABILITY: ARE YOU FLUENT IN ANY LANGUAGE OTHER THAN ENGLISH?

 No, I am only fluent in English.

 Yes, I am fluent in other languages. If yes, please indicate the language and fluency level below.

Language other than English: ______________________________________________________ Oral Fluency  Native Speaker  Fluent  Proficient  Limited Written Fluency  Fluent  Proficient  Limited  Non Existent Reading Fluency  Fluent  Proficient  Limited  Non Existent

Language other than English: ______________________________________________________ Oral Fluency  Native Speaker  Fluent  Proficient  Limited Written Fluency  Fluent  Proficient  Limited  Non Existent Reading Fluency  Fluent  Proficient  Limited  Non Existent

REFERENCES FOR APPLICANTS WHO ARE NEW TO CGU’S TEACHER EDUCATION. List the names of the three reference providers from whom we can expect letters of recommendation. Letters of Recommendation Forms can be found at:

www.cgu.edu/TeacherEducationAdmissionsInfo. Application isn’t considered complete until letters of recommendation are submitted.

 For the Preliminary Credential + MA Program, at least one should be from someone who can attest to your experience and effectiveness working with youth and at least one should attest to your academic abilities.

 For the Induction/Clear Program, the letters should address your 1) academic competence; 2) expertise working with diverse populations, including individuals with special needs; 3) teaching performance; and 4) professionalism.

 For the Autism Certificate/Authorization Program, at least one should be from someone who is qualified to evaluate your academic ability and one should be from a professional reference.

Name Title & Organization Address Email Address Telephone

STATEMENT OF SUPPORT FOR APPLICANTS WHO ARE A RECENT ALUMNUS OF CGU’S TEACHER EDUCATION PROGRAM.

Applicants who are a recent alumnus of CGU’s Teacher Education Program (within the past five years) have the option of providing two “statements of support” from personnel from CGU’s Teacher Education Program instead of three reference letters/forms._{Statements of} Support Forms can be found at www.cgu.edu/TeacherEducationAdmissionsInfo.



I am a recent alumnus of CGU’s Teacher Education Program (within past 5 years) and have submitted/will submit statements of support from the following CGU Teacher Education personnel:

1. ______________________________________________________________________________________ (name) 2. ______________________________________________________________________________________ (name)

________________________

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CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM

APPLICATION FOR ADMISSION.

Core application for all Teacher Education Programs.

CGU Teacher Education Application; revised April 2012

page 6

POST-SECONDARY EDUCATION. List all undergraduate and graduate institutions you have attended.

Name of Institution _{Country of Institution}City, State/Province, Indicate Degree or Transferred

(If no degree)

Degree Date:

Granted or Anticipated Major

GPA

(convert to a 4 pt scale)

POST-SECONDARY TRANSCRIPTS. Official transcripts are required from each post-secondary institution. International students are

encouraged to visit the “Apply Now” page at www.cgu.edu/apply for guidelines on submitting acceptable transcripts. If official

transcripts are not immediately available, unofficial transcripts maybe submitted and then replaced by official transcripts at a later date. Application isn’t considered complete until transcripts are submitted. An applicant who is a recent alumnus of CGU (within past 5 years) is not required to submit post-secondary transcripts unless he/she has attended another program since graduating from CGU.

 I am a recent alumnus of CGU (within past 5 years) and, hence, am not required to provide official transcripts. (Exception: If you have attended another program since graduating from CGU, you should submit transcripts from this program as CGU won’t have these on file.)

 Transcripts attached.

 Will submit in near future. I understand that my application will not be considered complete until I do so.

CURRENT RESUME.

 Attached.

 Will submit in near future. I understand that my application will not be considered complete until I do so.

STATEMENT OF PURPOSE/WRITING SAMPLE. Please compose and then submit an essay of approximately four-five pages (typed,

double spaced) addressing the following:

 Why are you pursuing this program? In what ways do your reasons reflect your personal values and professional goals?  What special gifts (intellectual, linguistic, physical and spiritual) or special interests or experiences (athletics, art or music,

travel or volunteer work) do you bring with you to the challenge of teaching/working with youth?  Please describe in detail your experiences teaching/working with youth.

 What needs to be done in today’s schools that you are personally committed to addressing in your work with youth?  Please describe the role that the principles of academic excellence, social justice and integrity have played in your own life

and how you would encourage the development of these principles in your work.

An applicant who is a recent alumnus of CGU (within past 5 years) is not required to submit a statement of purpose/writing sample.



I am a recent alumnus of CGU’s Teacher Education Program (within past 5 years) and hence am not required to submit a statement of

purpose/writing sample.



Attached.



Will submit in near future. I understand that my application will not be considered complete until I do so.

APPLICANT SIGNATURE

I certify that the information given by me on this application and all supporting materials provided are complete and accurate. I have omitted no substantive information. I hereby grant CGU permission to verify any information, including financial information, provided on this form and/or supporting documents.

I understand that any misrepresentation may be cause for denying admission or, if discovered after admission, dismissal from Claremont Graduate University and revoking of any degree and/or financial support granted.

I agree to promptly report any changes to the information provided in this application to the Office of Admissions & Records. I understand I may be requested to provide or release academic information if requested by a fellowship donor, and understand that choosing not to do so may result in withdrawal of monies awarded to me.

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CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM

APPLICATION FOR ADMISSION.

For Preliminary Credential + MA Program Only.

PLEASE NOTE THAT THIS PAGE IS ONLY FOR THOSE APPLYING TO CGU’S

PRELIMINARY CREDENTIAL + MA PROGRAM

STANDARDIZED TESTS FOR APPLICANTS TO CGU’S PRELIMINARY CREDENTIAL + MA PROGRAM. Arrange to have your test

scores submitted by the testing agency directly to CGU. Unofficial copies may be used for initial admission reviewing purposes. A copy of your official test scores and/or copies of test registration forms should be sent to CGU’s Teacher Credential Analyst via Fax (909/607-7793) or mail (925 North Dartmouth Ave., Claremont, CA 91711).

CBEST: California Basic Educational Skills Test (http://www.cbest.nesinc.com/).

 Registered to take but haven’t yet taken the CBEST. Planning on taking: _______________________ (date of test)

 Have taken the CBEST but haven’t yet received scores. Date took test: _______________________

 Have taken the CBEST and my highest scores thus far are as follows:

 WRITTEN Portion: ___________score, _____________________date of test

 READING Portion: ___________score, _____________________date of test

 MATH Portion: ___________score, _____________________date of test

CSET: California Subject Examinations for Teachers (http://www.cset.nesinc.com). SUBJECT: ________________________________________

 Registered to take but haven’t yet taken the CSET. Planning on taking: _______________________ (date)

 Have taken the CSET but haven’t yet received scores. Took test: ______________ (date)

 Have taken the CSET and my highest scores thus far are as follows:

 SUBTEST I: _______passed or ___________highest score thus far. _____________________date of test

 SUBTEST II: _______passed or ___________highest score thus far. _____________________date of test

 SUBTEST III: _______passed or ___________highest score thus far. _____________________date of test

 SUBTEST IV: _______passed or ___________highest score thus far. _____________________date of test

SUBJECT-MATTER WAIVER. (ALTERNATIVE TO CSET for SINGLE-SUBJECT CANDIDATES ONLY)

 I have submitted/will be submitting materials for a subject-matter waiver and, hence, will not take the CSET.

__________________________________________ _______________________________________ __________________

Subject Area University Date

TOEFL or IELTS



I am an International Student and have submitted/will submit TOEFL or IELTS scores.

________________________

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CLAREMONT GRADUATE UNIVERSITY

ADDITIONAL REQUIRED FORMS.

For Induction/Clear Program Only.

________________________

FOR OFFICE USE ONLY

PLEASE NOTE THAT THIS PAGE IS ONLY FOR THOSE APPLYING TO CGU’S

INDUCTION/CLEAR PROGRAM

PREVIOUS INDUCTION PROGRAM INVOLVEMENT. Please check one.

 I have not participated in any other Induction Program.

 I have participated in another Induction Program, and I have/will provide CGU’s Induction Program Coordinator with verification of the following information.

Name of Program:____________________________________________ Dates of Involvement:__________________________________

TEACHING HISTORY – DURING PRELIMINARY CREDENTIAL. Attach an additional sheet if necessary.

NAME OF SCHOOL, DISTRICT, AND

LOCATION GRADE LEVEL(S) TEACHING CAPACITY

 CGU Resident  CGU Intern  Non-CGU Intern

 Traditional Student Teacher

 Other:___________________________  CGU Resident

 CGU Intern  Non-CGU Intern

 Traditional Student Teacher

 Other:___________________________

TEACHING HISTORY – POST-PRELIMINARY CREDENTIAL. Attach an additional sheet if necessary.

NAME OF SCHOOL,

DISTRICT, AND LOCATION GRADE LEVEL(S) TEACHING CAPACITY REASON FOR LEAVING?

 Paid Teacher on Contract  Day-to-Day Substitute  Long Term Substitute  (Unpaid) Volunteer  Other:_________________

_________#years at site?  Presently employed  RIF

 Was promoted to another position within the school district

 Left teaching profession  Family Leave

 Other:________________________

INTEREST IN A GRADUATE DEGREE FROM CGU’S SCHOOL OF EDUCATIONAL STUDIES? Check any that apply. The

academic units of CGU’s Induction/Clear Program can be applied to a MA or PhD from CGU’s School of Educational Studies if the teacher is admitted into one of these graduate programs. Being accepted into CGU’s Induction/Clear Program does not mean that the teacher has been admitted into a CGU MA or PhD Program. A separate application is required for admission into such a program.

 I will not likely apply any of the units earned in CGU’s Induction/Clear Program to a graduate degree.

 I do not currently have a Master’s Degree, and I am considering pursuing a Master’s Degree from CGU’s School of Educational Studies in the near future.

 I have a Master’s Degree and am considering pursuing either a second Master’s Degree or a PhD at CGU’s School of Educational Studies in the near future.

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CLAREMONT GRADUATE UNIVERSITY

ADDITIONAL REQUIRED FORMS.

For Induction/Clear Program Only.

________________________

PLEASE NOTE THAT THIS PAGE IS ONLY FOR THOSE APPLYING TO CGU’S

INDUCTION/CLEAR PROGRAM

MODE OF PROGRAM DELIVERY. Please check one.

 Geo(graphically)-Near. I am interested in CGU’s “Geo-Near” Induction/Clear Program. I live geographically near to CGU. I plan on doing the Clinical Component of my Induction/Clear Program in a setting within (approximately) 40 miles of CGU, and I plan on primarily taking classes at CGU and/or meeting with CGU staff/faculty in person at CGU.

 Geo(graphically)-Far. I am interested in CGU’s “Geo-Far” Induction/Path Program. I live geographically far from CGU. I plan on doing the Clinical Component of my Induction/Clear Program in a setting far away from CGU (approximately more than 40 miles from CGU, whether that location is in Central/Northern California, in another state, or even outside of the USA), and I plan on primarily taking classes at CGU and/or meeting with CGU staff/faculty using virtual tools.

CLINICAL SETTING FOR INDUCTION/CLEAR.

CGU’s Induction Program is a two-semester program. In each semester there is a clinical

component and an academic component. Applicants are expected to secure their own clinical setting for Induction using the criteria listed below.  Standards-Based Curriculum. Setting must allow Participating Teacher to design and implement lessons based on the California content

standards in the subject of the PT’s credential.

 Length of Service. For fall and spring terms: must be a minimum of 12 weeks per term, with a minimum of 3 hours of instructional time per week teaching the same group of students. For summer term: must be a minimum of 4 weeks, with a minimum of 9 hours of instructional time per week teaching the same group of students. Smallest group of students: 5.

Please note that an applicant can apply to CGU’s Induction Program even if he/she is employed at a school with an active BTSA Induction Program (no CL-855 letter needed). Additionally, if the proposed clinical setting is not deemed appropriate, the applicant will be contacted by CGU’s Induction Program Coordinator to discuss how the proposed setting does not meet the criteria.

 I do not have a suitable clinical setting and, hence, have/will contact CGU’s Induction Program Coordinator (Tel: 909/621-8076) for guidance.

 I would like to propose the following setting:

Information on Proposed Clinical Setting

Name of Proposed Clinical Setting ___________________________________________________________________ Street Address___________________________________________________________________________________ City _______________________________ State ________________ Postal___________ Country _______________ Phone Number______________________________________ Fax _________________________________________ Supervisor’s Name_____________________________________ Email______________________________________

Proposed Setting’s Type. Check one.

 Public school district – traditional setting  Public school district – alternative setting  Public school district – adult education  Non-public school

 Charter school

 Private school – religious  Private school – nonsectarian  * After school program

 * Home school setting  * Pre-school

 * Summer program/camp  * Correctional facility

 * Rehabilitation center or hospital  * Community center

 * Tutoring for a “for profit” company

 * Other: _______________________________________

Applicant’s Role at the Proposed Setting_.

 Paid Employee – Full time  Paid Employee – Part time

 Long term substitute. Length of contract: ____________________________  Unpaid Volunteer

 Other ________________________________________________________(specify)

***************************************************************************************************************************************************************** Only answer the following if your Proposed Setting Type (above) is not a traditional 5-day/week classroom setting in the Fall/Spring term. Dates & Hours of Service at the Proposed Setting.

Starting Date __________________ (mm/dd/year) Ending Date __________________ (mm/dd/year) Total weeks of instruction: __________________________________________ (calculate above info) Number of instructional hours per week________________________________

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CLAREMONT GRADUATE UNIVERSITY

ADDITIONAL REQUIRED FORMS.

For Teacher Education Programs Only.

________________________

FINANCIAL AID APPLICATION FORM

FOR CGU’s TEACHER EDUCATION APPLICANTS ONLY

EDUCATIONAL FINANCING (Please advise CGU of your plans for and interests in financing your education.)

 Please consider me for CGU departmental financial support in the form of Fellowship, Research/Teaching Assistant Positions, and Stipends. (Fill out information below.*)

 Please consider me for Minority Aid. (Fill out information below.*)

 I have/will apply (or have applied) for Federal Student Aid using the FAFSA (Free Application for Federal Student Aid at www.fafsa.ed.gov**). o ** CGU’s institutional code for the FAFSA is G01169.

 I will be sponsored by my company or government to be assisted in or reimbursed for my educational costs.

 I am not applying for financial aid from CGU.

U.S. Citizens and Permanent Residents: To apply for Federal Financial Aid, please complete the Free Application for Federal Student Aid (FAFSA) found at www.fafsa.ed.gov**. The priority deadline to be considered for federal work-study is March 2 for those entering in the fall term.

** CGU’s institutional code for the FAFSA is G01169.

Third-Party Support or Company Reimbursement Sponsor or Company:

_________________________________________________________________________________________________________________________ Amount and terms of support:

_________________________________________________________________________________________________________________________

***************************************************************************************************************************************************************** Only answer the following if you are asking for Departmental or Minority Aid.

Request for Fellowship/Departmental Aid

Please complete the sections below to the best of your ability; estimate for future projections based on your expected financial situation while attending CGU. Decisions about admissions and institutional financial support are made independently of each other. Information contained in this form and its attachments, if any, WILL NOT influence the admission decision. The information you provide is confidential and will not be shared with third parties outside CGU without your permission except in anonymous statistical form. Please be sure to attach separate sheets of paper to describe any special circumstances that would help us when considering financial support for you.

Family Information

Number and ages of dependents (excluding self and spouse): _______________________________________________________________ In your household, how many persons, including self and spouse, are dependent upon income and assets shown below? ________________ Income Information (use annual figures) previous year current year next year (projected) Self (employment gross income) $ ______________________ $ ______________________ $____________________ Spouse $______________________ $ ______________________ $____________________ Other income $ ______________________ $ ______________________ $____________________

Specify source of other income: _______________________________________________________________________________________ Expense Information (use annual figures) previous year current year next year (projected) Rent or mortgage $ ______________________ $ ______________________ $ ____________________ Fixed Expenses $ ______________________ $ ______________________ $ ____________________

(expenses that will remain the same regardless of your income or where you live, e.g. loan payments, utilities, alimony, child support, car payment)

Other Expenses $ ______________________ $ ______________________ $ ____________________ Asset Information (current value) Applicant and Spouse (if applicable)

Cash, savings, certificates $ _________________________________________________________________________________________ Investments (e.g. stocks, bonds, trusts) $ _______________________________________________________________________________ Home and other real estate equity (if you rent, write Ø) $ ___________________________________________________________________ Trust Funds $ _____________________________________________________________________________________________________ Financing Your Previous Education

Monthly payments on undergraduate loans: _________________ Total borrowed: _________________ Balance remaining: ______________ Monthly payments on graduate loans: ______________________Total borrowed: _________________ Balance remaining: ______________

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CLAREMONT GRADUATE UNIVERSITY

Optional Admissions Survey

________________________

Applicant Last/Family Name: __________________________________________ Applicant First Name: _____________________________________ Applicant Date of Birth: __________- __________- __________ Email Address: _________________________________________________________ Semester for which I am applying: Fall of 20_______ Spring of 20 _______ Summer of 20 _______

Academic program to which I am applying: ______________________________________________________________________________________

Your response in the following sections is voluntary and confidential and will only be used for statistical purposes. It will not impact the status of your application.

I am the first person in my family to pursue a graduate education: Yes No

I may need special services to accommodate a physical, perceptual, or learning disability: Yes No I am a US Veteran: Yes No

I am currently serving in the US Armed Forces: Yes No

If yes: Branch Serving: __________________________ Rank: _____________________________ Status: Active Duty Reserve Anticipated End Date of Duty: _______________

Ethnicity and Race (for US Citizens and US Permanent Residents) I identify with the following ethnicity/race (Please select only one.): _____ Hispanic/Latino(a)

_____ Not Hispanic/Latino(a)

Furthermore, I identify with the following: (Select all with which you identify.) _____ American Indian or Alaska Native

_____ Asian

_____ Black or African American

_____ Native Hawaiian or Other Pacific Islander _____ White

The following people and/or resources influenced my decision to apply to CGU.

CGU faculty member. Who? ____________________________________________ (50) Your employer/co-worker (57) CGU staff member. Who? ______________________________________________ (58) Family or friends (56)

Current CGU student. Who? ____________________________________________ (51) GRE/GMAT locator service (20) CGU alumna or alumnus. Who? _________________________________________ (52) GRE/GMAT forum (23)

Claremont Colleges faculty, staff or alum. Who? _____________________________ (53) CGU visit to your company/campus.

Faculty member at your institution. Who? __________________________________ (55) Which site? _______________________(24) Other graduate school reference/guide. Which? _____________________________ (10) CGU website (33)

Other. Please specify: _________________________________________________ Peterson’s Guide (13) _______________________________________________________________________ (98)

Newspaper advertisement. Which paper? __________________________________ (28) Radio advertisement. Which station? ______________________________________ (32) Other CGU promotional materials. Which? _________________________________ (27) Below is my rating of various factors in my consideration of CGU. I have circled my choices.

very important not important not applicable

Reputation of faculty 1 2 3 4 5 N/A

Reputation/quality of the academic department 1 2 3 4 5 N/A

CGU’s overall reputation 1 2 3 4 5 N/A

Location 1 2 3 4 5 N/A

Flexibility of curriculum 1 2 3 4 5 N/A

Personal contact with CGU faculty and/or staff 1 2 3 4 5 N/A

Quality of academic facilities 1 2 3 4 5 N/A

Graduate-only institution 1 2 3 4 5 N/A

Responsiveness to your inquiry 1 2 3 4 5 N/A

Membership in the Claremont Colleges Consortium 1 2 3 4 5 N/A

CGU career services 1 2 3 4 5 N/A

Diversity of faculty and student body 1 2 3 4 5 N/A

Visit to campus 1 2 3 4 5 N/A

Influence of undergraduate advisor 1 2 3 4 5 N/A

If admitted, how important will the availability of

Fellowship aid be in your decision to attend CGU? 1 2 3 4 5 N/A

Other colleges/universities to which I am

applying:__________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________