Graduate Program Application Form

The Office of Admission is still accepting applications for fall 2013 for both the Community Psychology and Leadership & Community Development programs.

Please review the graduate application checklist when applying for the Graduate Program at Marymount College.

If you need help, contact the director of graduate admissions and continuing education at GraduateAdmission@marymountpv.edu or call 310-303-7212.

Anticipated Entrance: *

Fall

Spring

Summer

Degree Applied for: *

Master of Science in Community Psychology

Master of Science in Leadership & Community Development

Year: *

Last Name: *

First Name: *

Middle:

Address: *

City: *

State: *

Zip: *

Country: *

Home phone:

Cell phone:

Email: *

Maiden Name:

Maiden name and any previous names used on academic records.

Date of Birth: *

Gender: *

Female

Male

List your academic honors, awards, scholarships, or publications:

List your credentials and/or certificates held :

Residency: *

U.S. (U.S. citizen)

PR (Permanent resident of U.S. – green card)

NR (Not a U.S. resident)

County of Birth: *

Country of Citizenship: *

A Number: If you are a lawful permanent resident of the United States, please indicate your alien registration (A) number.

I have the prerequisites for this program.:

YES

If NO, please explain:

I have the prerequisites for this program.:

YES

If NO, please explain:

Occupation: *

Present Employer: *

Address:

Position:

How Long?:

Dept.:

Work Phone:

Hispanic/Latino:

Yes

Select one or more race category with which you identify:

If Other, please enter your religion:

Applicant's Signature: *

Date: *

School 4:

Location 4:

F4:

T4:

Degree 4:

G4:

School 3:

Location 3:

F3:

Degree 3:

G3:

T3:

S2:

L2:

F2:

T2:

D2:

G2:

University/College :

Location :

From:

To:

Degree :

Grad.:

APPLICATION FOR GRADUATE ADMISSION

PREVIOUS EDUCATION

As applicable, request that official transcripts be sent to the Office of Graduate Admission for each institution you list below; for full transcript policy, visit:
http://www.marymountpv.edu/search/node/transcripts

List your education, starting with the most recent. (One school per line.)

INTERNATIONAL STUDENTS

Note: If you are not a U.S. citizen or permanent resident of the U.S., you must complete additional forms. Please follow up with the Office of Graduate Admission.

Name:

MARYMOUNT COLLEGE GRADUATES

CURRENT EMPLOYMENT

STATEMENT OF AGREEMENT

Please read the following carefully before signing:

I certify that the above information is complete and correct to the best of my knowledge.

Marymount College does not discriminate on the basis of race, color, national origin, religion, age, gender, disability, or status as a veteran in any of its policies, practices, or procedures.

As a Marymount undergraduate with a combined BA-MS in Psychology, I have completed PSYCH 150, a college-level statistics course, and PSYCH 240 with a grade of C or higher.

As a Marymount undergraduate with a combined BA-MS in Leadership and Community Development, I have completed GS 135 and a college-level statistics course at time of application with a grade of C or higher.

OPTIONAL

Ethnicity

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