APPLICATION FOR
ADMISSION FOR DEGREE
GRADUATE STUDY		 Graduate Studies Office
University Administration Building
Room 121
University at Albany
Albany, New York 12222
(518) 442-3980
e-mail: graduate@uamail.albany.edu
web: http://www.albany.edu/
PERSONAL INFORMATION
 
Mr.Ms.
Last Name (Family)
First Name(Given)
MI
Other
 
U.S. Social Security #:     Birth Date:  Month:    Day:    Year: 
 
Permanent Mailing Address: Current Mailing Address (If different from permanent address):
  Valid until (Mo./Day/Yr.)
Street 1

Street 2:
 Street 1:

Street 2:
City:
 		 State:
 		 Zip:
Country:

Telephone Number:

Business Number:

Email:
City:
 		 State:
 		 Zip:
Country:

Telephone Number:

Business Number:

Email:
 
I voluntarily seek to identify myself as disabled and request information regarding available University services to support disabled individuals:   Yes   No

  1. Are you a New York State resident?
    Yes   For how long?  Years   Months     
    Please indicate NY county of residence: 

       No    Please indicate state/country of residence: 

  2. Student Ethnic Data:  
    (Data collected will be used to prepare statistical summaries of the various enrollment categories as mandated by federal reporting requirements. Individuals are not identified in these reports. You are not required to provide this information.)
       White, non-Hispanic (Not of Hispanic Origin)    Black, non-Hispanic (Not of Hispanic Origin)     Hispanic/Latino
       Asian or Pacific Islander   American Indian  / Native Alaskan    Other 

FOR INTERNATIONAL APPLICANTS:

Country of Citizenship:     Proposed Visa Status:


City and Country of Birth:     Current Visa Status:

PROGRAM INFORMATION Semester and Year you wish to enter:    Fall    Spring    Summer     Year:      
 Full-time study      Part-time study

Field of Study and Degree Level

When admitted, will you hold or expect to hold a valid USA teaching certificate?
Yes    In what academic area?      No

Have you previously applied to Graduate Study at the University at Albany?    Yes    No
If yes:
Month   Year    Academic Program      Action Taken: 

ACADEMIC HISTORY
 (Please consult the application instructions on how to correctly submit official transcripts.)
Institution & Location
(List the most recent first)		 Dates of Attendance Degree &
Major Field
(i.e. B.S. in Chemistry)		 Date Degree
Received
or Expected		 Grade
Point
Average
  From:
Month/Year		 To:
Month/Year		      


Please give the dates the following exams were taken (or will be taken) and the scores received
(See the Application Instructions)
GRE General Test:
  Mo. Yr. Verbal Quantitative Analytical
GRE Subject Test:  
  Mo. Yr. Score Subject
GMAT:
  Mo. Yr. Verbal Quantitative Total
TOEFL/IELTS:
  Mo. Yr. Score

FINANCIAL AID INFORMATION

If you are seeking consideration for graduate assistantship, fellowship or scholarship support, please complete and submit either or both of the applications available from the following links:


RECOMMENDATIONS

(Please consult the application instructions on how to correctly submit official recommendations.)
  First Last Title Affiliation
Name:
Name:
Name:
 
STATEMENT OF BACKGROUND AND GOALS

A typewritten Statement of Background and Goals is required and must be submitted on your own stationery. Please use whatever format is convenient for you. The statement should contain a brief description of your field of interest, related background, desired study and/or research emphasis and your career goals. A resume may not be substituted for this statement but may be included with the application.

EMPLOYMENT EXPERIENCE  (Please list recent work experience.)
Occupation
(list current first)		 Employer Dates of Service Employer's Address
    From:
Month/Year		 To:
Month/Year		 City State

Have you ever been convicted of a felony?    Yes     No
Have you been dismissed from a college for disciplinary reasons?    Yes     No
Please indicate which sources prompted you to apply to graduate study at the University at Albany. Please indicate all that apply.
 program information received from the University at Albany
 faculty member at your university
 alumni contact
 campus visit
 broadcast media (i.e. T.V., radio)
 electronic access (i.e. world wide web, internet)
 i.e., newspapers, magazines
 listing in a college guide  (please specify): 
 attendance at a specialized admissions forum in 
 a poster advertising an academic program at the University at Albany
 acquaintance enrolled in a program at the University at Albany
 academic reputation of the graduate program
 geographic location
 other 
I certify that the information provided in this application is true and complete to the best of my knowledge. I am aware that if the information provided in this application proves to be inaccurate, I may not be admitted to graduate study and/or my registration will be terminated.  Yes

Date: 


University at Albany, State University of New York does not discriminate on the basis of age, color, creed, disability, marital status, national origin, race, or sex. Inquiries concerning the policy should be directed to the Office of Diversity and Affirmative Action.