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Graduate Application For Admission

It is recommended that you print this form in order to keep a copy for your files.

 
School of  Graduate Studies
Southern Arkansas University

P. O. Box 9302
Magnolia, AR  71754-9302

 
Fill out all fields below that apply to you.   Use the Tab key on your keyboard to move between fields.

This is required information. Incomplete applications will not submit.

NOTE: In order to apply electronically the applicant's Social Security number must be provided.

Social Security Number
(Example: 123456789)

I. Personal Demographic Information

Title

         

Name

   
First Name 

    
Middle Name
Type none if no middle name 

    
Last Name


 Suffix


Preferred Name

       

Other Last Names used on records


Type none if this does not apply to you.
   


 

Mailing
Address


Street/P.O. Box

 
 


City


  State


Zip code

 
County

  Country
 
Date of Birth
(MMDDYYYY)
Gender

Telephone   Number


Home Phone
(Example: 8702351234)

 
  Work Phone
 
(Example: 8702351234)

 
  Cell Phone
  (Example: 8702351234)

E-mail Address

 

FAX No.

 

Ethnic Background
Optional - for federal/state reporting purposes only - This information will be used in a nondiscriminatory manner consistent with civil rights laws.

 

Colleges and universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions:

Do you consider yourself to be Hispanic/Latino?

 

In addition, select one or more of the following racial categories to describe yourself:

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White

 

Are you a US Citizen? 

   
  If no, country where you hold citizenship  
What is your state of legal residence? (see definition below)
How long has this been your legal residence immediately prior to attending SAUM?
Legal residence means the legal home and place of permanent living of the student for all purposes. For purposes of paying fees, this residency must be (at least) for the last six continuous months. An out-of-state student enrolled for a full, or substantially full, program of credits at an educational institution is considered to be in Arkansas primarily for the purpose of attending school and not for the purpose of establishing in good faith a true, fixed and permanent home constituting an Arkansas domicile. Applicants who are not U.S. Citizens should select 'Foreign Country' as their state of legal residence.

II. Educational  Information

Seeking admission as:

If you are seeking a degree, what is your intended program/major?      

If you are not seeking a degree, please select purpose of enrollment:

If License Renewal, specify license type:

Enrollment Date:

III. Educational Background

High School /
GED Institution

 


City


State 

High School graduation / GED year
(YYYY)
 
Are you presently on academic suspension  or academic probation  from any college or university?
If so, please explain in detail below.


Have you previously attended SAU Magnolia?


Undergraduate Coursework:

Please list all baccalaureate work completed at colleges/universities you have attended including Southern Arkansas
University, Magnolia. List the college or university where your baccalaureate degree was earned (or will be earned) first. List the anticipated graduation date for Year of Degree if you are currently working on your baccalaureate degree. If your college or university is not listed, please select the state where it is located. Please complete all requested information -- selecting NONE or N/A where applicable. Incomplete applications will not submit.

Name and location Dates Attended Year of Degree Baccalaureate Degree Baccalaureate Degree Not Listed


Graduate Coursework:

Please list all graduate work completed at colleges/universities you have attended including Southern Arkansas University, Magnolia. Please list the most recently attended college or university first. If the college or university is not listed, please select the state where it is located. Please complete all columns shown -- selecting NONE or N/A where applicable.

Name and location Dates Attended Year of Degree Master's Degree Master's Degree Not Listed


Licenses:

Please list current teaching licenses (type NONE in first text box line if not applicable).



Teaching Experience:

Total years of teaching experience 

IV. Disciplinary

Have you ever been convicted, pleaded guilty, or are you presently charged by indictment or
information with a crime (a felony) which might be punishable by imprisonment in a penitentiary? 

Have you ever been committed to a correctional or training institution? 

If the answer to either question is "yes", give details below.

Court Date Name of Court Name of Offense Status of charge Penalty imposed/
other disposition

 

I affirm that the information which I have provided on this application form and all other admission material is complete, accurate, and true.  I authorize each high school and each college, university, or school I have attended or agency from which I have received education credentials to release academic and personal information as related to this admission application upon request by Southern Arkansas University, Magnolia (SAU).

I agree to submit other materials which are required for this admission application and understand that failure to do so and /or the furnishing of false, incomplete, or misleading information in connection with my admission or attendance at Southern Arkansas University, Magnolia may at any time result in the termination of my admission and registration at SAUM.

I agree that as a student I am subject to the Southern Arkansas University, Magnolia Code of Student Conduct.

I agree that directory information as defined by the Family Educational Rights and Privacy Act will be available to the general public unless I notify the vice president for student affairs no later than the end of registration week each semester or term that all or part of the directory information should not be released without prior consent.  Directory information means information contained in an education record of a student that would not generally be considered harmful or an invasion of privacy if disclosed.  It includes, but is not limited to, the student's name, address, telephone listing, electronic mail address, photograph, date and place of birth, major field of study, dates of attendance, grade level, enrollment status (e.g., undergraduate or graduate; full-time or part-time), activities and sports, weight and height of members of athletic teams, degrees, honors and awards received, and the most recent educational agency or institution attended.

I understand that submitting this application will serve as my permission for the Office of Graduate Studies and advisors of this program to have access to my academic records and test scores. 

By submitting this information to Southern Arkansas University you are agreeing to the above statement.

Southern Arkansas University, Magnolia is committed to the policy of providing educational opportunities to all qualified students regardless of their economic or social status, and will not discriminate on the basis of race, age, color, sex, disability, or national origin.

When you have completed the Online Graduate Application for Admission, click the "Submit" button ONE TIME ONLY. We recommend you print the application before submitting, in case there are problems with your submission.