Doctor of Education Application

Doctor of Education (Educational Leadership) Application

Please fill out the form and hit the submit button.
(* denotes a required field).

 

PERSONAL INFORMATION

First Name: *

Last Name: *

Home Address: *

City: *

State: *

Zip: *

Home Phone Number (999-999-9999): *

Work Phone Number (999-999-9999):

Cell Phone Number (999-999-9999):

Fax Number (999-999-9999):

Preferred Email: *

Social Security Number (999-99-9999): *

Date of Birth (99/99/9999): *

Country of Birth:

Gender: Male Female

Marital Status: Single Married Divorced Separated Widowed

Number of Children:

Are you a U.S. Citizen? Yes No

If you answered NO above, are you a PERMANENT RESIDENT? Yes No

Are you a U.S. Veteran? Yes No

Are you a post 9/11 Veteran? Yes No

Are you currently active? Yes No

Are you a spouse or dependent of a Post 9/11 Veteran? Yes No

How did you learn about the University of St. Francis?

If you selected Other, please specify:

Your response to the following will in no way affect your admission status. The information is requested so that the University of St. Francis may demonstrate its compliance with Federal Regulations and may compile meaningful statistics.

What is your ethnicity? Hispanic or Latino Not Hispanic or Latino

What is your race? (choose one or more) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Is English your first language? Yes No

What is the Primary Language spoken at home?

Religious Preference:

If you selected other, please specify:

 

ACADEMIC INFORMATION

Which Concentration are you registering for?
Superintendent Certification Courses
Stewardship, Leadership & Learning Courses

Applying for: (Fall and YYYY) *

Please list where your Masters Degree was obtained below (Include name, location, dates attended, degree/diploma, graduation date) (Exmaple: Jones University, Aug. 1977 to May 1981, MS Computer Science, May 1981):

 

CURRENT EMPLOYMENT INFORMATION

Title/Position:

Dates Employed:

Employer:

City/State/Zip:

Does your employer offer tuition reimbursement?
Yes No

If yes, what is the amount per year?

Are you interested in student loans?
Yes No

Please list Memberships in professional organizations below:

List all honors or scholastic distinctions you have received. Give titles of any articles or other publications and of any research or other creative work you have done below:

 

READ CAREFULLY and CHECK THE BOX BELOW

I certify that all information provided is correct and complete.

I understand that it is my responsibility to request all college/university transcripts be sent directly to the University of St. Francis, Office of Admissions, 500 Wilcox St., Joliet, IL. 60435

Withholding information or giving false information in the sections above will invalidate this application and may result in dismissal. It is the policy of the University of St. Francis not to discriminate on the basis of sex, age, race, color, disability, or national/ethnic origin in its admission practices, educational programs, activities or employment policies as required by the Federal Civil Rights Laws.

By typing your initials below, I read and understood the above statements: *