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Application

This two-page document is an application for graduate admission to American International College's Extended Campus Programs. It requests basic contact and background information from applicants such as name, address, education history, employment, and program of interest. Applicants must select a preferred location, degree, licensure type, and program of study. By signing, applicants agree to the selected program registration and understand falsified information could result in lost credit or dismissal.

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Chris Fontaine
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41 views

Application

This two-page document is an application for graduate admission to American International College's Extended Campus Programs. It requests basic contact and background information from applicants such as name, address, education history, employment, and program of interest. Applicants must select a preferred location, degree, licensure type, and program of study. By signing, applicants agree to the selected program registration and understand falsified information could result in lost credit or dismissal.

Uploaded by

Chris Fontaine
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Extended Campus Programs

Application for Graduate Admission (Page 1 of 2)


Please complete and sign the following application and return along with your $50 non-refundable application fee and Program Agreement by fax to (800) 504-7618 or by mail to American International College, Attn: Kerry Reiter, Extended Campus Programs, 1000 State St., Box 2B, Springfield, MA 01109.

Ms. Mrs. Miss Mr. Dr.


Last First

Date of Birth ______________


Middle Previous/Maiden Name

__________________________________________________________________________________________ __________________________________________________________________________________________
Street Address Apartment No.

__________________________________________________________________________________________
City State Zip Code

Home Phone (

) _________________

Mobile Phone (
Street Address

) _________________Work Phone (

)_____________
City

Mailing Address (if different from above) ___________________________________________________________

__________________________________________________________________________________________
State Zip Code Telephone Number

E-Mail address ______________________________________ Position/Title ___________________________________ Current Employer ___________________________________ Dates Employed _________________________________
Street Address

_________________________________________________________________________________________
City State Zip Code

LIST ALL COLLEGES AND UNIVERSITIES YOU HAVE ATTENDED

Name of College

City and State

Dates Attended

Degree/Date

Undergraduate Major: ____________________________________________________________ PREVIOUS EMPLOYMENT


Employer Location Dates Employed Job Title

1. ________________________________________________________________________________________________ 2. ________________________________________________________________________________________________ 3. ________________________________________________________________________________________________ Do you hold a valid teaching license/certificate? Yes No If yes, please send a copy.*
*You will not be registered for classes until a valid license is received.

Have you passed the Communication and Literacy MTEL? Yes No If yes, please send a copy of the score sheet. Country of Birth _______________________Citizenship: United States Other: __________________________ Gender: Male Female
Ethnicity: Race and ethnicity unknown For non-Hispanics only:

Nonresident alien Hispanics of any race Asian White Black or African American Two or more races

American Indian or Alaska Native Native Hawaiian or Other Pacific Islander

Transfer Credit Request - (Check only if interested in a transfer credit evaluation) By checking this box, I understand AIC accepts a maximum
of 9 graduate level credits. Course descriptions must be submitted prior to having a transfer credit evaluation completed. No request for transfer credit will be accepted after the student has begun their program.

While a student may begin coursework without a complete admissions file, financial aid is permitted only when all application materials have been received and the student is fully accepted.

Extended Campus Programs


Application for Graduate Admission (Page 2 of 2)

Please answer questions 1-4 to select your location and program:


1. What is your preferred Program Location? Medford Pittsfield Weymouth Worcester Greenfield/Orange Springfield

2. What Degree are you seeking? Please select one: Master of Education Certificate of Advanced Graduate Studies (C.A.G.S.) For those who have earned a Master's Degree Master of Arts (School Guidance & School Adjustment Only) -- Springfield Campus Only 3. What Licensure are you seeking? Please select one: Initial License Professional License - For those who intend to advance their Initial License within the same area of concentration. Degree Only - For those who are not seeking Massachusetts DESE licensure Professional License Only 12 credit hour non-degree program for those who already hold a Master's Degree and intend to advance their license within the same area of concentration. (Professional License available for Early Childhood, Elementary Ed., Moderate Disabilities Pre K-8 only) 4. What Program are you enrolling in? Please select one: Early Childhood Education (Pre K-2) Elementary Education (1-6) Moderate Disabilities (Pre K-8) Moderate Disabilities (5-12) Middle School Education (5-8) not available as Professional License Please circle subject area: Secondary Education (8-12) not available as Professional License Please circle subject area:
Business Biology Chemistry English French Business Biology Chemistry English French History Math Political Science Spanish General Science

Reading (Pre K-12) not available as Professional License - applicants must hold at least an initial level teaching license and have one year teaching experience. School Administration - not available as Professional License; Please circle subject area:
Principal/Assistant Principal (PreK-6 / 5-8 / 9-12) Special Ed Administrator Supervisor / Director (Area/Level: ________________________) Superintendent/Assistant Superintendent

History

Math

Political Science

Spanish

*School Adjustment Counseling (Pre K-12) *School Guidance (Pre K-8) *School Guidance (5-12)
I understand that by signing this application, I will be registered for the first semester of the above selected program and that I remain registered for these 8 week courses unless written notification is submitted to the Office of Extended Campus Programs before the second class of the first 8 week course. I verify that the information provided on this application is true and correct. I understand that the falsification or withholding of any information in regard to this application may result in a loss of credit and dismissal from the institution.

*Offered in Springfield ONLY

Student Signature: _______________________________________________ Date: ____/____/____


Fax to: 800-504-7618: Mail to: American International College Attn: Kerry Reiter Extended Campus Programs 1000 State St., Box 2B, Springfield MA 01109

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