APPLICATION for ADMISSION to the
5-Year BA/MA in Educational Psychology Program
(To be returned to Teacher Education Office by September 15th.
You will be contacted for an interview after this date)
Name_______________________________ ______________________________CWID #____________________
Address_______________________________________________________________________________________
Email__________________________________________________________Phone_________________________
SSN#___________________________________
Current GPA:____________ Credits at end of semester_____________ Advisor ____________________________
Have you completed your field work (EDUC 091 Fieldwork in Education)?__________
For each of the following courses that you have taken, list the grade you received for the course:
EDUC 101 (Foundations)______
EDUC 150 (Learning Through Tech)______
PSYC 207 (Exceptional Child)______
PSYC 208 (Ed Psych)______
PSYC 317 (Child Dev.)______
EDUC 350 (Teaching Lang Arts)______
List two faculty members who will be providing references letters for you (see reference form for professors):
*Please remind each to return letters to Teacher Education office no later than September 15th!
Name_____________________________________
Name______________________________________
Position___________________________________
Position____________________________________
On a separate sheet of paper, write an essay describing why you are interested in this program and what makes it
suitable for you. See separate document for helpful ideas. Submit all materials listed below along with this
application. You will be called to an interview after September 15, only if all your materials are in file.
Student Signature________________________________________________
Date______________________
Return this completed form to Teacher Education Office by September 15th
For Office Use:
____Résumé
____ Essay
____ Recommendation letter 1 received
____ Recommendation letter 2 received
____ Unofficial Transcript from Degree Works
____ Undergraduate Study Plan (with marked 5 year graduate plan)
____ Interview completed
____ Accepted to 5 year B.A./M.A Program
NOTES: _____________________________________________________________________
________________________________________________________________Date________________________
Director of Graduate Education Program