G RADUATE A DMISSIONS A PPLICATION
PERSONAL INFORMATION
Please Print clearly
Last/Family name First name
Middle name Maiden
Home address
City State Zip code Country
Home telephone ( ) Work telephone ( )
Cell phone ( ) Email
U.S. Social Security Number (if applicable) ___ ___ ___ ___ ___ ___ ___ ___ ___
Have you ever been convicted of a misdemeanor or felony? !"no !"yes If the answer is yes, please explain
(OFFICE USE ONLY) ID
Amount Receipt Southern Adventist University is a private, Christian university. In a manner consistent with all
applicable laws and regulations, it is open to all and does not discriminate on the basis of age, gender, race, color, ethnic or national origin, or disability in the administration of its educational policies, programs, and activities including its admissions policies, financial programs, and other university-administered programs.
FORNON-U.S. CITIZENSONLY
Country of birth Citizenship
Permanent resident # Alien visa (type)
(a photocopy of your green card or visa must accompany this application)
FORSTATISTICALPURPOSES
Your disclosure/non-disclosure of the information below will not affect your eligibility for admission. The federal government requests that we collect this data for statistical purposes.
Birth date (m/d/y)
Gender !"Male ! Female Marital status !"Single !"Married Ethnic origin !"Black/African American !"American Indian/Alaskan Native !"Asian !"Hispanic/Latino
" !"White !"Native Hawaiian/Other Pacific Islander !"Two or more races !"Race and ethnicity unknown
Religious affiliation Church (if SDA)
Conference (if SDA) Union (if SDA)
PROGRAMDATA
For which degree are you applying? (Please note specific program and concentration/emphasis, list attached)
! MA ! MS ! MBA ! MFM ! MSA ! MMin
!"MSN ! RN-MSN ! MSN/MBA ! MSEd ! MSW
Concentration/Emphasis !"Full-time student ! Part-time student
Anticipated location of enrollment (check all that apply) ! On-campus ! Off-campus !"Online
Anticipated term of enrollment ! Summer (May/June) 20 ! Fall (Aug) 20 !"Winter (Jan) 20
Graduate Application S OUTHERN A DVENTIST U NIVERSITY
EDUCATIONALHISTORY
Have you previously attended Southern Adventist University? !"no !"yes
Attended from (m/y) to (m/y) Degree received and date Student ID# (if any)
Please list all colleges and universities you have attended and degree conferred.
Name of institution City, State, Country
Attended from (m/y) to (m/y) Degree and major completed
Date of conferral (m/y) Name of institution City, State, Country
Attended from (m/y) to (m/y) Degree and Major completed
Date of conferral (m/y)
Employing organization Title or office
Location
Dates from (m/y) to (m/y)
PROFESSIONALHISTORY
Please include present or most recent positions or jobs held. If you prefer, you may submit your current resume (use an additional sheet if needed).
Name of institution City, State, Country
Attended from (m/y) to (m/y) Degree and major completed
Date of conferral (m/y) Name of institution City, State, Country
Attended from (m/y) to (m/y) Degree and Major completed
Date of conferral (m/y)
Employing organization Title or office
Location
Dates from (m/y) to (m/y)
Name Position
Address Phone
Name Position
Address Phone
REFERENCES
Please provide two references:
How did you hear about Southern? ! Radio ! Website ! Billboard ! Ads !"Personal Contact
! Other
Other names(s) under which transcript may be issued
DISABILITYSERVICES
Students with physical or academic disabilities that could impact their learning experiences, who qualify for accommodations or special services, must contact the Learning Success Center at 423.236.2868. Southern is in compliance with Section 504 of the Rehabilitation Act (1973) and is dedicated to the elimination of architec- tural and prejudicial barriers which prevent any qualified person from attending.
PLEDGE
I voluntarily agree to uphold the ideals, standards, and principles set forth in the Southern Adventist University Graduate Catalog and Student Handbook and pledge my cooperation and loyalty. Since Southern is a Seventh-day Adventist institution, I understand that the values and standards of the church are reflected in the university rules and regulations.
By registering at Southern Adventist University, students authorize the use and reproduction by the university, or anyone authorized by the university, of any pictorial images taken of them while enrolled at Southern, without compensation. All negatives, positives, and prints shall constitute Southern Adventist University property, solely and completely.
I also understand that my signature below indicates that all the information given in this application is factually correct and honestly presented.
_______________________________________________________________________________________________________________________________ _________________________________________ _____________________________________________________________________________________________________________________________
Signature Date Print your full name
Mail this graduate application form to:
Graduate Studies, Southern Adventist University, Post Office Box 370, Collegedale, TN 37315-0370, USA
INSTRUCTIONS
In order for this application to be complete, the following must be sent to Graduate Studies at Southern Adventist University. Refer to the Graduate Catalog for additional admission prerequisites.
• Official transcripts of undergraduate degree course work
• Two recommendations; three for the Counseling emphasis (forms provided)
• $25 application fee (nonrefundable)
• GRE or GMAT score (as required by your program)
• TOEFL score (required of international students whose first language is not English) School of Business and Management only
• Essay of 250 words or less describing a) reason for enrolling in the program, b) what the program will enable you to do professionally.
• If you have not taken accounting, business, and finance, you must take appropriate courses or take a waiver exam.
School of Nursing only
• Essay of 250 words or less describing a) your academic and professional goals, b) expectations of the program, c) any related talents, skills, collegiate and/or professional accomplishments, community activities, or other personal achievements.
• Tennessee RN license # Expiration date
• Have you been convicted of a crime other than a minor traffic violation? ! yes ! no
• Have you been on probation, suspended, or dismissed from any school? ! yes ! no If the answer is yes to either of the above, please explain
School of Religion only
• If a pastor, what year did you enter the ministry?
Are you an ordained minister? ! yes ! no If yes, date of ordination?
Are you conference sponsored? ! yes ! no If yes, what conference?
APPLICATIONDEADLINES
• Fall semester - July 1
• Winter semester - November 1
• Summer term - April 1
School of Nursing
• Fall Semester - May 1
• Winter Semester - October 1
Phone: 1.800.SOUTHERN Fax: 423.236.1694
Email: [email protected] Web: graduatestudies.southern.edu
Graduate Programs and Concentrations
S OUTHERN A DVENTIST U NIVERSITY
Use this list of degrees and emphases offered by Southern to select your area of study as requested
under the section “Program Data” on the graduate application form.
Master of Business Administration (MBA) Accounting
Church and Non-Profit Leadership
Healthcare Administration (on campus, online) Human Resource Management
Management (on campus, online, chattanooga) Marketing Management
Master of Financial Services (MFS)
Master of Science in Administration (MSA) Church Administration
Customized Leadership
Outdoor Education Master of Science (MS)
Clinical Mental Health Counseling School Counseling
Master of Science in Education (MSEd) Inclusive Education (hybrid)
Instructional Leadership Literacy Education (hybrid) Outdoor Teacher Education Master of Science in Nursing (MSN)
Adult Nurse Practitioner Family Nurse Practitioner Nurse Educator
Master of Science in Nursing/Master of Business Administration (MSN/MBA)
RN to MSN Accelerated Program (RN-MSN) Adult Nurse Practitioner
Family Nurse Practitioner Nurse Educator
Master of Science in Nursing/Master of Business Administration
Post-Master’s Certification Adult Nurse Practitioner Family Nurse Practitioner Nurse Educator
Master of Ministry (MMin)
Church Leadership and Management Church Ministry and Homiletics Evangelism and World Mission Master of Arts in Religion (MA)
Biblical and Theological Studies Religious Studies
Master of Social Work (MSW)*
Child and Family Advocacy and Treatment International Social Work
Marital Therapy and Stability Trauma and Emergency Response Older Adult Enrichment
*Pending the approval of The Southern Association of Colleges and Schools (SACS), and the Council on Social Work Education, Southern is set to offer a new Master of Social Work degree by Fall 2010.
PART I — TOBECOMPLETEDBYAPPLICANT
__________________________________________________________________(print name of applicant) is applying for admission to the gradu- ate studies program at Southern Adventist University. The applicant is asked to identify individuals who can provide information to the graduate studies council to assist in the admission process for the applicant.
Under the provision of the Federal Family Educational Rights and Privacy Act of 1974 (must check one):
❍ I (applicant) retain the right to review this form ❍ I (applicant) waive my right to review this form
________________________________________________________________________________________________________________________
Applicant's Signature Date
PART II — TOBECOMPLETEDBYAPPRAISER
Applicant is requesting admission to Southern Adventist University and has given your name as a reference. We value your comments and ask that you give a full and candid report so that fair consideration may be given the applicant. We therefore ask for careful ratings and comments about the applicant’s character and ability. An incomplete report may lessen the applicant's chances of admission.
What is or has been your relationship with the applicant? _____________________________________________________________________________________________________________________________________________________________________
How long have you known the applicant? ___________________________________________________________________________________________________________________________________________________________________________________________________
SUPERIOR EXCELLENT VERY GOOD GOOD FAIR LACK
(UPPER 5%) (UPPER 10%) (UPPER 25%) (UPPER 40%) (LOWER 50%) INFORMATION
Intellectual ability ❍ ❍ ❍ ❍ ❍ ❍
Written expression ❍ ❍ ❍ ❍ ❍ ❍
Analytical thinking ❍ ❍ ❍ ❍ ❍ ❍
Oral communication ❍ ❍ ❍ ❍ ❍ ❍
Motivation/perseverance ❍ ❍ ❍ ❍ ❍ ❍
Interpersonal relations ❍ ❍ ❍ ❍ ❍ ❍
Commitment to service ❍ ❍ ❍ ❍ ❍ ❍
Integrity ❍ ❍ ❍ ❍ ❍ ❍
Emotional stability ❍ ❍ ❍ ❍ ❍ ❍
RECOMMENDATIONIN HIGHEST HIGHLY RECOMMENDED RECOMMENDED NOT
CONSIDERATIONOF: RECOMMENDATION RECOMMENDED WITHCONFIDENCE WITHRESERVATIONS RECOMMENDED
Academic qualifications ❍ ❍ ❍ ❍ ❍
Nonacademic qualifications ❍ ❍ ❍ ❍ ❍
Comments: (Additional comments can be submitted on a separate sheet) ____________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Signature ___________________________________________________ Title _______________________________________________________
Print Name _________________________________________________ Date _______________________________________________________
Telephone ( ) ____________________________________________ Email ____________________________________________________________________
Check the school to which you are applying:
❍ BUSINESS ❍ NURSING ❍ SOCIAL WORK ❍ EDUCATION/PSYCHOLOGY ❍ RELIGION
Graduate Recommendation
