PITTSBURG STATE UNIVERSITYINTERNATIONAL APPLICATION FOR ADMISSION TO GRADUATE STUDY

Office of Continuing and Graduate Studies

Preliminary Questions:(* Required field)

1) *Are you a United States citizen or permanent resident? Yes _____ No _____

2) *What will your status be as you enter Pittsburg State University?

Undergraduate: Degree Seeking at Pittsburg State University ____ Exchange ____

Graduate: Masters Degree ____ Educational Specialist ____ Exchange ____

Other: Intensive English Program ____ Paraguay Program ____

About Me:

1) *Name as it will appear on your legal documents (print):

2) *Date of Birth ________________ 3) *Gender: Male ______ Female ______ (MM/DD/YY)

My Contact Information:1) *Permanent Home Country Address Information:

_____________________________________________________________________________Street/box number

_____________________________________________________________________________ City State/Province Postal Code Country

Telephone Number ________________________________________________________ Country Code, City (area) Code and Phone Number2) Immigration Document (I-20) Mailing Address Information:(if different than Permanent Home Country Address)

________________________________________________________________________ Street/box number

________________________________________________________________________ City State/Province Postal Code Country

Telephone Number ______________________________________________________ Country Code, City (area) Code and Phone Number

Last (Family) First MI Other Name

3) U.S. Mailing Address Information:(if different than Permanent Home Country Address)

________________________________________________________________________ Street/box number

________________________________________________________________________ City State Postal Code

Telephone Number ______________________________________________________ Area Code and Phone Number

4) Other:

My Cell Phone Number is: ______________________________

Do You Want To Receive Admission Text Messages? Yes ____ No ____

My Fax Number is: ____________________________________

*My E-mail address is: _________________________________________

My Current Visa Type (if any) is: B-1 ____ B-2 ____ F-1 ____ F-2 ____

H-1b ____ H-4 ____ J-1 ____ J-2 ____

Would you like us to send your documents by Express Mail?(requires an additional $45 fee) Yes ____ No ____

My College/University:*List all colleges/universities attended:

Name ofCollege/Universities City, Country

StartDate

EndDate Anticipated/Final Degree Earned

Date Anticipated/Final Degree Earned

My International Information:

1) *What is your Birth City? ___________________________________________________

2) *What is your Birth Country? ________________________________________________

3) *What is your Citizenship Country? ___________________________________________

4) *What is your Residence Country? ____________________________________________

5) I heard about Pittsburg State University from:

Friend ____ Internet ____

Family ____ US Education Guides (usedguides.com) ____

My School ____ US Journal (usjournal.com) ____

Agent ____ Other ____

(List other source: _____________________)

6) *Will you bring dependents into the United States? Yes ____ No ____

(If yes, please fill out a dependent form for each person accompanying you. The dependent form is available at http://www.pittstate.edu/dotAsset/36492.pdf)

My English Proficiency:

Pittsburg State University requires a minimum Test of English as a Foreign Language (TOEFL) orInternational English Language Test System (IELTS) score for admittance or university credit courses.The minimum required scores are:

TOEFL: 68 (internet based test) / 520 (paper based test)

IELTS: Overall score of 6.0

(A minimum score of 6.0 in each band is required. If a lower score is earned in any of the five band scores, the overall score cannot be accepted.)

Some degree programs require a higher TOEFL/IELTS score for admission.Please go to this site to verify TOEFL/IELTS score requirements for the program you are interested in:http://www.pittstate.edu/cgs/toefl.html.

If this requirement is not met, you must complete the Intensive English Program (IEP) before attendinguniversity credit courses.

* Please choose the category that best fits your situation:

____ Yes, I have met or plan to meet the English Requirement

____ I took, or will take, the TOEFL in ______ ______ and my score was ______ (month) (year)

(You must submit a copy of your TOEFL score or have the TOEFL score sent directly from ETS,the testing agency. The code for Pittsburg State University is 6336)

____ I took, or will take, the IELTS in ______ ______ and my score was ______ (month) (year)

(You must submit a copy of your IELTS score, or have the IELTS score sent directly fromIELTS, the testing agency)

____ I am currently attending or have completed IEP at Pittsburg State University

____ No, I will not meet the English requirement but plan to begin with the IEP program

I plan to begin IEP in:

Fall (August) __________ Spring (January) Year Year

Summer (June) __________

Fall (October) _________ Spring (March) __________

Year

Year Year

My Program of Study:* I would like to begin graduate study in

Fall (August) _____ Spring (January) _____ Summer (June) _____Year Year Year

* Please circle a degree program from the list on the following page.

Advanced Studies in Leadership (Gen School Admin), EDS**

Advanced Studies in Leadership (Special Education), EDS**

Biology, MS

Business Administration (Accounting), MBA

Business Administration (General Administration), MBA

Business Administration (International Business), MBA

Career & Technical Ed. (Family & Consumer Science), MS

Career & Technical Ed. (College Teaching), MS

Career & Technical Ed. (Technology Education), MS

Career & Technical Ed. (Technical Teacher Education), MS

Chemistry, MS

Communication, MA

Counseling (Clinical Mental Health), MS

Counseling (School), MS

Counseling (Community), EDS**

Counseling (School), EDS**

Educational Leadership, MS

Educational Technology (Library Media), MS

Educational Technology (Tech Integration Specialist), MS

Engineering Technology, MET

English (Literature), MA

English (Professional/Technical Writing), MA

English (Composition and Rhetoric), MA

English (Creative Writing), MA

Health, Human Perf. & Rec. (Human Perf. & Wellness), MS

Health, Human Perf. & Rec. (Sport & Leisure Serv Mmgt), MS

Health, Human Perf. & Rec. (General), MS

History, MA

Human Resource Development (Mgt. & Consulting), MS

Human Resource Development (Prog. Dev. & Delivery), MS

Mathematics, MS

Music (Performance – Harpsichord), MM

Music (Performance – Winds), MM

Music (Performance – Strings), MM

Music (Performance – Percussion), MM

Music (Performance – Organ), MM

Music (Performance – Piano), MM

Music (Wind Conducting), MM

Music (Vocal Performance), MM

Music (Instrumental Education), MM

Music (Vocal Education), MM

Music (Choral Conducting), MM

Nursing (Family Nurse Practitioner), MSN

Nursing (Family Health Education), MSN

Nursing (Family Health Administration), MSN

Physics, MS

Psychology (Clinical), MS

Psychology (General), MS

Reading (Classroom Reading Teacher), MS

Reading (Reading Specialist Certification), MS

School Psychology, EDS**

Special Education Teaching (Adaptive, Pre K-12), MS

Special Education Teaching ( Functional K-6, 6-12), MS

Teaching (English for Speakers of Other Languages), MS

Teaching (Secondary), MA

Teaching (Special Education), MA

Teaching (Elementary), MS

Teaching (Secondary), MS

Technology, MS

Technology (Printing Management), MS

** In order to apply for an EdS program, you must have a Master's Degree and submitMaster's Degree transcripts with your application

Workforce Development & Education, EDS**

Application Fee

1) Application fee of $60.00 is non-refundable

2) Express Mail fee is $45 (optional)

4) If you pay the application fee by check or money order:- be sure to write the name of the applicant clearly on the check or money order- make it payable to PSU or Pittsburg State University

5) Please do not send cash

I am sending: $60 Application Fee ____ $45 Express Mail ____

TOTAL AMOUNT SENT: $__________

Check Check # ________

By submitting this application, I certify that the information provided is complete, accurate and trueand agree to abide by the admission policies and requirements of Pittsburg State University. Iunderstand that information given falsely or withheld could affect the decision on my application andmay make me ineligible for admission and/or enrollment. Verification of response may be requested

for any applicant.

________________________________________ _______________________ Signature of Applicant Date

3) If you wish to pay by credit card, you will need to pay the fee(s) online. Once we have received your application, you will receive an e-mail from us with that information. At that time, please log in to the Graduate System in GUS and click on the Admittance tab. On that screen, you will be able to input your credit card information to pay the fee(s). Please do not send credit card information to us.

Money Order