GRADUATE STUDIES APPLICATION FORM

Please complete and return to the Faculty of Graduate Studies

Application Deadline
Although applications are accepted on a continual basis, to be considered in the initial admission & funding decisions for Fall (September)
st st
semester, students are encouraged to apply by February 1 . Applications received after February 1 may be considered for admission.

Application Fee $50

A non-refundable application fee of $50 (CDN) must be included with the application.
Applications received without the application fee will not be processed.

SECTION A: Biographic Information

Have you applied to/registered at Lakehead University previously?  NO  YES When?

Previous Lakehead University Student ID Number

Title (Mr. Ms. Mrs. Miss) Proper Given/First Name Surname/Family Name

Birth Date (yymmdd) Former Surname/Family Name

Citizenship  Canadian Citizen

 Permanent Resident (Landed Immigrant) – Date Received:
 Study Permit / Student Visa

Country of Citizenship If not born in Canada, state date of entry into Canada First Language

Mailing Address:

Street City

Province/State Country Postal Code

( ) ( )
Area Code Home Telephone No. Area Code Business Telephone No. E-mail Address

Would you like to declare Aboriginal Ancestry?  No  Yes

If Yes, please select one of the following:  Status  Non-Status  Inuit  Metis

SECTION B: Previous Education Information

*Please indicate all post-secondary institutions that you have attended or are currently attending

Institution Name Dates Attended (from - to) Degree/Diploma Completed

SECTION C: Program Choice Information

Anticipated Session of Enrollment:
September  Year NOTE: Students in a Master’s program must complete all
January  program requirements within six terms of continuous
May  registration full-time.

Last updated May 20, 2010 1

Please choose one of our available programs:
SUBJECT DEGREE
BUSINESS Master of Science in Management Only available at the Thunder Project 
Bay campus Thesis 
Master of Business Administration (MBA) – Full-Time option Only available at the Thunder Course 
Bay campus
Master of Business Administration (MBA) – Part-Time option Thunder Bay campus Course 
Master of Business Administration (MBA) – Part-Time option Orillia campus Course 
BIOLOGY Master of Science Thesis 
BIOTECHNOLOGY PhD 
CHEMISTRY Master of Science Thesis 
COMPUTER SCIENCE Master of Science Thesis  Course 
ECONOMICS Master of Arts Course 
EDUCATION Master of Education – Standard Option * Thesis  Portfolio Course 
Master of Education – Flex Option * Thesis  Portfolio Course 
Master of Education & Specialization in Gerontology – Thesis  Portfolio Course 
Standard Option *
Master of Education & Specialization in Gerontology – Flex Thesis  Portfolio Course 
Option *
Master of Education & Specialization in Women’s Studies – Thesis  Portfolio Course 
Standard Option *
Master of Education & Specialization in Women’s Studies – Thesis  Portfolio Course 
Flex Option *
* Will you be completing any portion of the program’s requirements through Distance Education:
Yes 
ENGINEERING Master of Science – Control Engineering Thesis 
Master of Science – Electrical & Computer Engineering Thesis 
Master of Science – Environmental Engineering Thesis 
ENGLISH Master of Arts Thesis  Course  Project 
Master of Arts & Specialization in Women’s Studies Thesis  Course  Project 
FORESTRY Master of Science Thesis 
Master of Forestry Project 
PhD – Forest Sciences 
GEOLOGY Master of Science Thesis 
HISTORY Master of Arts Thesis  Course  Project 
Master of Arts & Specialization in Women’s Studies Thesis  Course  Project 
KINESIOLOGY Master of Science Thesis 
Master of Science & Specialization in Gerontology Thesis 
MATHEMATICS Master of Arts Course 
Master of Science Course 
OUTDOOR Master of Environmental Studies – Thesis 
RECREATION Nature-based Recreation & Tourism
GEOGRAPHY / Master of Environmental Studies – Northern Environments Thesis 
ANTHROPOLOGY and Cultures
PHYSICS Master of Science Thesis  Course 
PSYCHOLOGY Master of Arts – Clinical Thesis 
Master of Arts – Clinical & Specialization in Gerontology Thesis 
Master of Arts – Clinical & Specialization in Women’s Thesis 
Studies
Master of Science – Experimental – General Stream Thesis 
Master of Science – Experimental – General Stream & Thesis 
Specialization in Gerontology
Master of Science – Experimental – Applied Health Thesis 
Research Stream
Master of Science – Experimental – Applied Health Thesis 
Research Stream & Specialization in Gerontology
PhD – Clinical 

Last updated May 20, 2010 2

PROGRAM LIST CONTINUED ON NEXT PAGE….

SUBJECT DEGREE
PUBLIC HEALTH Master of Public Health – Standard Option * Course  Thesis 
Master of Public Health – Flex Option * Course  Thesis 
Master of Public Health – Specialization in Gerontology – Course 
Standard Option *
Master of Public Health – Specialization in Gerontology – Course 
Flex Option *
Master of Public Health – Nursing Stream – Standard Course 
Option *
Master of Public Health – Nursing Stream – Flex Option * Course 
Master of Public Health – Nursing Stream & Specialization Course 
in Gerontology – Standard Option *
Master of Public Health – Nursing Stream & Specialization Course 
in Gerontology – Flex Option
* Will you be completing the program through Distance Education: Yes 
SOCIAL WORK Master of Social Work Project 
Master of Social Work & Specialization in Gerontology Project 
Master of Social Work & Specialization in Women’s Project 
Studies
SOCIOLOGY Master of Arts Research Paper 
Master of Arts & Specialization in Gerontology Research Paper 
Master of Arts & Specialization in Women’s Studies Research Paper 

NURSE PRACTITIONER Primary Health Care Nurse Practitioner Certificate Full-Time  Part-Time 
Please note that this is not a graduate program. The Office of Graduate Studies administers the application and admission
procedures for the program. Additional program information is available through the School of Nursing.

Please complete if known:

Area of Research Interest Potential Supervisor

Proposed Referees (3)

Name Title

IMPORTANT
Personal information on this form is collected under the general authority of the Act Respecting Lakehead University and will be used to aid
both deliberations on admission eligibility and essential administrative functions after admission. Any questions on this collection should be
directed to: Office of Graduate and International Studies, Lakehead University, 955 Oliver Road, Thunder Bay, Ontario P7B 5E1, Telephone:
(807) 343-8527. It is the student’s responsibility to become familiar with the academic and financial regulations and penalty dates as published
by Lakehead University. Please note that applications will not be considered complete and admission decisions cannot be made until all
supporting documentation is received.

I hereby certify that the information provided on this application is accurate and complete. I understand that incomplete, inaccurate or false
statements or documents may cause my admission or registration to be rescinded. I also understand that admission requirements must be met
before registration takes effect. In addition, misrepresentation of my legal status in Canada could result in legal penalties. I am prepared to
provide proof of my citizenship if required.

Signature of Applicant Date

Please submit all application materials to: Faculty of Graduate Studies

Lakehead University
955 Oliver Road
Thunder Bay, ON P7B 5E1

Last updated May 20, 2010 3

 Faculty of Graduate Studies

GRADUATE STUDIES APPLICATION FEE: $50.00 CDN

Please include your payment and one copy of this payment form with your Graduate Studies Application Form.
Graduate Studies Applications will not be processed until the application fee is received.

Please Print

Surname/Family Name Given/First Name Birth Date

Street Address City Province

( )
Country Postal Code Area Code and Phone Number

Program Applied To E-mail Address

Please ensure that the contact information provided here exactly matches your application.

PAYMENT OPTIONS:

 Money Order in Canadian Dollars, PAYABLE TO LAKEHEAD UNIVERSITY

(PLEASE STAPLE THE MONEY ORDER TO THIS FORM)

 Credit Card:

 Visa  MasterCard

Cardholder Name

Card Number

Expiry Date

Cardholder Signature

Please submit to:

Faculty of Graduate Studies

Lakehead University
955 Oliver Road
Thunder Bay, ON
P7B 5E1

For Office Use Only:

Student ID

Last updated May 20, 2010 4