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NEW STUDENT APPLICATION
TEACHER EDUCATION PROGRAMS
SUBMIT VIA MAIL, EMAIL, OR HAND DELIVERY.
Office of Admissions
Claremont Graduate University
160 E. 10th St.
Claremont, CA 91711
Email as a scanned PDF: TeacherEdApplicationSubmission@cgu.edu
Hand deliveries accepted at above address Mondays-Fridays from 8:30am-5:00pm.
Office of Admissions
For all application-related inquiries: (909) 621-8069 • Admiss@cgu.edu
Teacher Education Office
For all program-related inquiries: (909) 607-3692 • TeacherEducation@cgu.edu
International Student Services
For all immigration-related inquiries: (909) 607-0434 • International@cgu.edu
CGU Teacher Education Application; revised April 2012
page 1
CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM
APPLICATION FOR ADMISSION.
Preliminary Credential + MA Program Applicants
PRINT, COMPLETE & SUBMIT:

The Core Application (pages 3–6)

The Additional Forms for Preliminary Credential + MA Program (page 7)

Financial Aid Application Form (page 10 )

Optional Survey. (page 11)
ALSO SUBMIT:

Application Fee or Fee Waiver Form

Statement of purpose/writing sample

Current resume

3 letters of recommendation

Post-secondary transcripts. Unofficial can be submitted and then replaced with official/sealed transcripts.

CBEST & CSET (and if applicable TOEFL or IELTS) scores and/or copies of registration forms.
*Induction/Clear Program Applicants *Note: There is a different application process for people in
CGU’s Preliminary Credential + MA Program who are taking the “Direct to Clear” Path.
PRINT, COMPLETE & SUBMIT:

The Core Application (pages 3–6)

The Additional Forms for the Induction/Clear Program (pages 8-9)

Financial Aid Application Form (page 10)

Optional Survey. (page 11)
ALSO SUBMIT:

Application Fee or Fee Waiver Form

Statement of purpose/writing sample. [N/A if you are a recent CGU Teacher Ed alumnus (within past 5 years.)]

Current resume

3 letters of recommendation (or if you are a recent CGU Teacher Education Alumnus, 2 statements of support)

Post-secondary transcripts. Unofficial can be submitted and then replaced with official/sealed transcripts. [N/A if you are
a recent CGU alumnus (within past 5 years.)]
Autism Certificate/Authorization Program Applicants
PRINT, COMPLETE & SUBMIT:

The Core Application (pages 3–6).

Financial Aid Application Form (pages 10).

Optional Survey. (pages 11).
ALSO SUBMIT:

Application Fee or Fee Waiver Form

Statement of purpose/writing sample. [N/A if you are a recent CGU Teacher Ed alumnus (within past 5 years.)]

Current resume

3 letters of recommendation (or if you are a recent CGU Teacher Education Alumnus, 2 statements of support)

Post-secondary transcripts. Unofficial can be submitted and then replaced with official/sealed transcripts. [N/A if you are
a recent CGU alumnus (within past 5 years.)]
ADMISSIONS DEADLINES
Applications to CGU are accepted on a rolling basis; therefore, we welcome applications year-round. Priority dates
are established to give top consideration to those who apply by the specified dates.
 July 1st is the priority deadline for candidates wanting to start a Teacher Education program in Fall/August.
 November 1st is the priority deadline for candidates wanting to start a Teacher Education program in
Spring/January.
 April 1st is the priority deadline for candidates wanting to start a Teacher Education program in
Summer/May.
CGU Teacher Education Application; revised April 2012
page 2
CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM
APPLICATION FOR ADMISSION. Core application for all Teacher Education Programs.
________________________
FOR OFFICE USE ONLY
CLAREMONT COLLEGES AFFILIATION







I am a





Current Student at…
Alumnus of…
Staff at…
Faculty at…
Dependent of Staff or Faculty member of
CGU/Claremont Colleges who works at….
Claremont McKenna
Harvey Mudd
Pitzer
Pomona
Scripps
KGI
CGU, Program______________________________________________
I am a 5Cs student/alumnus and have:
 taken EDUC 300G.
 taken EDUC 170G.
 taken other BA/MA classes approved for MA Electives for General Educators. _____________________________________ (name them)
APPLICATION FEE. Applicants are required to submit a $60 non-refundable application fee. Fee waived if the applicant is a
CGU/Claremont College student, alumnus, staff, or faculty or if there is financial hardship. Application Fee Waiver can be found at:
www.cgu.edu/TeacherEducationAdmissionsInfo.
PERSONAL INFORMATION. Please print legibly.
Last/Family Name: _________________________________________________________________________________________________________
First/Given Name: ______________________________________________________Middle Name: ________________________________________
Former /Other Family Name:__________________________________________________________________________________________________
Former/Other First Name:____________________________________________________________________________________________________
U.S. Social Security #: ________--______--________
Sex: Female_____ Male _____
Birth Date:(MM/DD/YYYY )_______- _______- __________
____ Visa Type:______________________
Citizenship:
Birth Country: ____________________________________ City: _______________________________ State/Prov: ____________________________
Primary Email Address: _______________________________________ Secondary Email Address: ________________________________________
Home Phone: (_____) _____________________
I have previously applied to CGU:
No
Cell Phone: (_____ ) _____________________
Work Phone: (_____ ) _____________________
Yes, for this semester and year: __________________________________________________________
ADDRESSES. Please write your address line-by-line as it should appear on an envelope including the postal code and country. If your
address changes at any time during your application process, notify admiss@cgu.edu so we can update your record.
Permanent Address (required)
Mailing Address (if different)
_________________________________________________________
___________________________________________________________
_________________________________________________________
___________________________________________________________
_________________________________________________________
___________________________________________________________
_________________________________________________________
___________________________________________________________
Good until: ______________ (Date)
CALIFORNIA CREDENTIAL VERIFICATION.
 I have a California Teaching Credential and have attached a copy. Additionally, I understand CGU will be verifying this information with the
California Commission on Teacher Credentialing (CCTC). (Teachers can obtain a copy of their credential at
https://teachercred.ctc.ca.gov/teachers/PersonalSearchProxy.)
Signature: _________________________________________________________________ Date: __________________________
CGU Teacher Education Application; revised April 2012
page 3
CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM
APPLICATION FOR ADMISSION. Core application for all Teacher Education Programs.
TEACHER EDUCATION PROGRAM TO WHICH YOU SEEK ADMISSION.
 Preliminary Credential + Master Degree Program.

General Education Credentials + MA in Education
________________________
FOR OFFICE USE ONLY
Induction / Clear Program:
 Multiple Subject Clear Credential

Multiple-Subject Credential

Single Subject Clear Credential

Single-Subject English / Language Arts

Education Specialist Clear Credential

Single-Subject Social Studies / History

Mild / Moderate

Single-Subject Spanish

Moderate / Severe

Single-Subject credential in Science


Physics

Chemistry

Biology / Life Science

Geo-Science

Autism Certificate/Authorization:
 Autism Certificate. CGU’s Autism Certificate
provides educators and community members with
information that allows them to better interact with
and serve students with Autism Spectrum Disorders
(ASD). By law, teachers must have appropriate
credentials/authorizations to work with students with
ASD. For General Education teachers and noncredentialed personnel, this Certificate does not
provide such legal authorization.
 Added Authorization in Autism. For
Mild/Moderate Education Specialists who
earned their credential prior to 2012,the
CGU’s Autism Certificate can be used to
meet the state’s legal requirement for an
“Added Authorization” in Autism.
Single-Subject Math

MA in Education

MA in Applied Mathematics
Education Specialist Credentials + MA in Education

Mild/Moderate

Moderate / Severe

Dual Education Specialists Credential Program:
Mild / Moderate + Moderate / Severe. I want to start with:


Mild / Moderate

Moderate / Severe
Expedited Education Specialist Credential (Mild / Moderate or
WHEN DO YOU WANT TO START YOUR
PROGRAM IN TEACHER EDUCATION?
Preliminary Credential + Master Degree Program
Moderate / Severe) for General Educators (Multiple- or
Single-Subject)

Mild / Moderate

Moderate / Severe

Spring / January ______________ Year

Summer / May

Fall / August
______________ Year
(For General Education Candidates only.)
______________ Year
Dual Education Specialist/General Education Credential + MA in
Education
Induction/Clear Program
Education Specialist Credential:

Mild / Moderate

Fall / August

Moderate / Severe

Spring / January ______________ Year

Summer / May
General Education Credential:
______________ Year
______________ Year

Multiple-Subject Credential

Single-Subject English / Language Arts

Single-Subject Social Studies / History

Single-Subject Spanish

Fall / August

Single-Subject credential in Science

Spring / January ______________ Year

Summer / May


Physics

Chemistry

Biology / Life Science

Geo-Science
Autism Authorization/Certificate
______________ Year
______________ Year
Single-Subject Math
CGU Teacher Education Application; revised April 2012
page 4
CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM
APPLICATION FOR ADMISSION. Core application for all Teacher Education Programs.
________________________
FOR OFFICE USE ONLY
LANGUAGE CAPABILITY: ARE YOU FLUENT IN ANY LANGUAGE OTHER THAN ENGLISH?
 No, I am only fluent in English.
 Yes, I am fluent in other languages. If yes, please indicate the language and fluency level below.
Language other than English: ______________________________________________________
Oral Fluency
Written Fluency
Reading Fluency
 Native Speaker
 Fluent
 Fluent
 Fluent
 Proficient
 Proficient
 Proficient
 Limited
 Limited
 Limited
 Non Existent
 Non Existent
Language other than English: ______________________________________________________
Oral Fluency
Written Fluency
Reading Fluency
 Native Speaker
 Fluent
 Fluent
 Fluent
 Proficient
 Proficient
 Proficient
 Limited
 Limited
 Limited
 Non Existent
 Non Existent
REFERENCES FOR APPLICANTS WHO ARE NEW TO CGU’S TEACHER EDUCATION. List the names of the three reference
providers from whom we can expect letters of recommendation. Letters of Recommendation Forms can be found at:
www.cgu.edu/TeacherEducationAdmissionsInfo. Application isn’t considered complete until letters of recommendation are submitted.

For the Preliminary Credential + MA Program, at least one should be from someone who can attest to your experience and
effectiveness working with youth and at least one should attest to your academic abilities.

For the Induction/Clear Program, the letters should address your 1) academic competence; 2) expertise working with diverse
populations, including individuals with special needs; 3) teaching performance; and 4) professionalism.

For the Autism Certificate/Authorization Program, at least one should be from someone who is qualified to evaluate your
academic ability and one should be from a professional reference.
Name
Title & Organization
Address
Email Address
Telephone
STATEMENT OF SUPPORT FOR APPLICANTS WHO ARE A RECENT ALUMNUS OF CGU’S TEACHER EDUCATION PROGRAM.
Applicants who are a recent alumnus of CGU’s Teacher Education Program (within the past five years) have the option of providing two
“statements of support” from personnel from CGU’s Teacher Education Program instead of three reference letters/forms. Statements of
Support Forms can be found at www.cgu.edu/TeacherEducationAdmissionsInfo.
 I am a recent alumnus of CGU’s Teacher Education Program (within past 5 years) and have submitted/will submit statements of support
from the following CGU Teacher Education personnel:
1.
______________________________________________________________________________________ (name)
2.
______________________________________________________________________________________ (name)
CGU Teacher Education Application; revised April 2012
page 5
CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM
APPLICATION FOR ADMISSION. Core application for all Teacher Education Programs.
POST-SECONDARY EDUCATION. List all undergraduate and graduate institutions you have attended.
Name of Institution
City, State/Province,
Country of Institution
Indicate Degree
or Transferred
(If no degree)
Degree Date:
Granted or Anticipated
Major
GPA
(convert to a
4 pt scale)
POST-SECONDARY TRANSCRIPTS. Official transcripts are required from each post-secondary institution. International students are
encouraged to visit the “Apply Now” page at www.cgu.edu/apply for guidelines on submitting acceptable transcripts. If official
transcripts are not immediately available, unofficial transcripts maybe submitted and then replaced by official transcripts at a later date.
Application isn’t considered complete until transcripts are submitted. An applicant who is a recent alumnus of CGU (within past 5 years)
is not required to submit post-secondary transcripts unless he/she has attended another program since graduating from CGU.
 I am a recent alumnus of CGU (within past 5 years) and, hence, am not required to provide official transcripts. (Exception: If you have


attended another program since graduating from CGU, you should submit transcripts from this program as CGU won’t have these on file.)
Transcripts attached.
Will submit in near future. I understand that my application will not be considered complete until I do so.
CURRENT RESUME.


Attached.
Will submit in near future. I understand that my application will not be considered complete until I do so.
STATEMENT OF PURPOSE/WRITING SAMPLE. Please compose and then submit an essay of approximately four-five pages (typed,
double spaced) addressing the following:
 Why are you pursuing this program? In what ways do your reasons reflect your personal values and professional goals?
 What special gifts (intellectual, linguistic, physical and spiritual) or special interests or experiences (athletics, art or music,
travel or volunteer work) do you bring with you to the challenge of teaching/working with youth?
 Please describe in detail your experiences teaching/working with youth.
 What needs to be done in today’s schools that you are personally committed to addressing in your work with youth?
 Please describe the role that the principles of academic excellence, social justice and integrity have played in your own life
and how you would encourage the development of these principles in your work.
An applicant who is a recent alumnus of CGU (within past 5 years) is not required to submit a statement of purpose/writing sample.
 I am a recent alumnus of CGU’s Teacher Education Program (within past 5 years) and hence am not required to submit a statement of
purpose/writing sample.
 Attached.
 Will submit in near future. I understand that my application will not be considered complete until I do so.
APPLICANT SIGNATURE
I certify that the information given by me on this application and all supporting materials provided are complete and accurate. I have omitted no
substantive information. I hereby grant CGU permission to verify any information, including financial information, provided on this form and/or supporting
documents.
I understand that any misrepresentation may be cause for denying admission or, if discovered after admission, dismissal from Claremont Graduate
University and revoking of any degree and/or financial support granted.
I agree to promptly report any changes to the information provided in this application to the Office of Admissions & Records. I understand I may be
requested to provide or release academic information if requested by a fellowship donor, and understand that choosing not to do so may result in
withdrawal of monies awarded to me.
Signature: _____________________________________________________________________________ Date: _____________________________
CGU Teacher Education Application; revised April 2012
page 6
CLAREMONT GRADUATE UNIVERSITY’S TEACHER EDUCATION PROGRAM
APPLICATION FOR ADMISSION. For Preliminary Credential + MA Program Only.
________________________
FOR OFFICE USE ONLY
PLEASE NOTE THAT THIS PAGE IS ONLY FOR THOSE APPLYING TO CGU’S
PRELIMINARY CREDENTIAL + MA PROGRAM
STANDARDIZED TESTS FOR APPLICANTS TO CGU’S PRELIMINARY CREDENTIAL + MA PROGRAM. Arrange to have your test
scores submitted by the testing agency directly to CGU. Unofficial copies may be used for initial admission reviewing purposes. A copy of
your official test scores and/or copies of test registration forms should be sent to CGU’s Teacher Credential Analyst via Fax (909/6077793) or mail (925 North Dartmouth Ave., Claremont, CA 91711).
CBEST: California Basic Educational Skills Test (http://www.cbest.nesinc.com/).

Registered to take but haven’t yet taken the CBEST. Planning on taking: _______________________ (date of test)

Have taken the CBEST but haven’t yet received scores. Date took test: _______________________

Have taken the CBEST and my highest scores thus far are as follows:

WRITTEN Portion:
___________score, _____________________date of test

READING Portion:
___________score, _____________________date of test

MATH Portion:
___________score, _____________________date of test
CSET: California Subject Examinations for Teachers (http://www.cset.nesinc.com). SUBJECT: ________________________________________

Registered to take but haven’t yet taken the CSET. Planning on taking: _______________________ (date)

Have taken the CSET but haven’t yet received scores. Took test: ______________ (date)

Have taken the CSET and my highest scores thus far are as follows:

SUBTEST I:
_______passed or ___________highest score thus far.
_____________________date of test

SUBTEST II:
_______passed or ___________highest score thus far.
_____________________date of test

SUBTEST III: _______passed or ___________highest score thus far.
_____________________date of test

SUBTEST IV: _______passed or ___________highest score thus far.
_____________________date of test
SUBJECT-MATTER WAIVER. (ALTERNATIVE TO CSET for SINGLE-SUBJECT CANDIDATES ONLY)
 I have submitted/will be submitting materials for a subject-matter waiver and, hence, will not take the CSET.
__________________________________________
Subject Area
_______________________________________
University
__________________
Date
TOEFL or IELTS
 I am an International Student and have submitted/will submit TOEFL or IELTS scores.
CGU Teacher Education Application; revised April 2012
page 7
CLAREMONT GRADUATE UNIVERSITY
ADDITIONAL REQUIRED FORMS. For Induction/Clear Program Only.
________________________
FOR OFFICE USE ONLY
PLEASE NOTE THAT THIS PAGE IS ONLY FOR THOSE APPLYING TO CGU’S
INDUCTION/CLEAR PROGRAM
PREVIOUS INDUCTION PROGRAM INVOLVEMENT. Please check one.
 I have not participated in any other Induction Program.
 I have participated in another Induction Program, and I have/will provide CGU’s Induction Program Coordinator with verification of the
following information.
Name of Program:____________________________________________ Dates of Involvement:__________________________________
TEACHING HISTORY – DURING PRELIMINARY CREDENTIAL. Attach an additional sheet if necessary.
NAME OF SCHOOL, DISTRICT, AND
GRADE LEVEL(S)
TEACHING CAPACITY
LOCATION










CGU Resident
CGU Intern
Non-CGU Intern
Traditional Student Teacher
Other:___________________________
CGU Resident
CGU Intern
Non-CGU Intern
Traditional Student Teacher
Other:___________________________
TEACHING HISTORY – POST-PRELIMINARY CREDENTIAL. Attach an additional sheet if necessary.
NAME OF SCHOOL,
DISTRICT, AND LOCATION
GRADE LEVEL(S)
TEACHING CAPACITY
REASON FOR LEAVING?





Paid Teacher on Contract
Day-to-Day Substitute
Long Term Substitute
(Unpaid) Volunteer
Other:_________________
_________#years at site?
 Presently employed
 RIF
 Was promoted to another position
within the school district
 Left teaching profession
 Family Leave
 Other:________________________





Paid Teacher on Contract
Day-to-Day Substitute
Long Term Substitute
(Unpaid) Volunteer
Other:_________________
_________#years at site?
 Presently employed
 RIF
 Was promoted to another position
within the school district
 Left teaching profession
 Family Leave
 Other:________________________





Paid Teacher on Contract
Day-to-Day Substitute
Long Term Substitute
(Unpaid) Volunteer
Other:_________________
_________#years at site?
 Presently employed
 RIF
 Was promoted to another position
within the school district
 Left teaching profession
 Family Leave
 Other:________________________
INTEREST IN A GRADUATE DEGREE FROM CGU’S SCHOOL OF EDUCATIONAL STUDIES? Check any that apply. The
academic units of CGU’s Induction/Clear Program can be applied to a MA or PhD from CGU’s School of Educational Studies if the
teacher is admitted into one of these graduate programs. Being accepted into CGU’s Induction/Clear Program does not mean that the
teacher has been admitted into a CGU MA or PhD Program. A separate application is required for admission into such a program.




I will not likely apply any of the units earned in CGU’s Induction/Clear Program to a graduate degree.
I do not currently have a Master’s Degree, and I am considering pursuing a Master’s Degree from CGU’s School of Educational Studies in the
near future.
I have a Master’s Degree and am considering pursuing either a second Master’s Degree or a PhD at CGU’s School of Educational Studies in
the near future.
I have a Ph.D., and I am considering pursuing a second Ph.D. at CGU’s School of Educational Studies.
CGU Teacher Education Application; revised April 2012
page 8
CLAREMONT GRADUATE UNIVERSITY
ADDITIONAL REQUIRED FORMS. For Induction/Clear Program Only.
________________________
FOR OFFICE USE ONLY
PLEASE NOTE THAT THIS PAGE IS ONLY FOR THOSE APPLYING TO CGU’S
INDUCTION/CLEAR PROGRAM
MODE OF PROGRAM DELIVERY. Please check one.
 Geo(graphically)-Near. I am interested in CGU’s “Geo-Near” Induction/Clear Program. I live geographically near to CGU. I plan on doing

the Clinical Component of my Induction/Clear Program in a setting within (approximately) 40 miles of CGU, and I plan on primarily taking
classes at CGU and/or meeting with CGU staff/faculty in person at CGU.
Geo(graphically)-Far. I am interested in CGU’s “Geo-Far” Induction/Path Program. I live geographically far from CGU. I plan on doing the
Clinical Component of my Induction/Clear Program in a setting far away from CGU (approximately more than 40 miles from CGU, whether that
location is in Central/Northern California, in another state, or even outside of the USA), and I plan on primarily taking classes at CGU and/or
meeting with CGU staff/faculty using virtual tools.
CLINICAL SETTING FOR INDUCTION/CLEAR. CGU’s Induction Program is a two-semester program. In each semester there is a clinical
component and an academic component. Applicants are expected to secure their own clinical setting for Induction using the criteria listed below.
 Standards-Based Curriculum. Setting must allow Participating Teacher to design and implement lessons based on the California content
standards in the subject of the PT’s credential.
 Length of Service. For fall and spring terms: must be a minimum of 12 weeks per term, with a minimum of 3 hours of instructional time per
week teaching the same group of students. For summer term: must be a minimum of 4 weeks, with a minimum of 9 hours of instructional time
per week teaching the same group of students. Smallest group of students: 5.
Please note that an applicant can apply to CGU’s Induction Program even if he/she is employed at a school with an active BTSA Induction Program (no
CL-855 letter needed). Additionally, if the proposed clinical setting is not deemed appropriate, the applicant will be contacted by CGU’s Induction
Program Coordinator to discuss how the proposed setting does not meet the criteria.


I do not have a suitable clinical setting and, hence, have/will contact CGU’s Induction Program Coordinator (Tel: 909/621-8076) for guidance.
I would like to propose the following setting:
Information on Proposed Clinical Setting
Name of Proposed Clinical Setting ___________________________________________________________________
Street Address___________________________________________________________________________________
City _______________________________ State ________________ Postal___________ Country _______________
Phone Number______________________________________ Fax _________________________________________
Supervisor’s Name_____________________________________ Email______________________________________
Proposed Setting’s Type. Check one.
 Public school district – traditional setting
 Public school district – alternative setting
 Public school district – adult education
 Non-public school
 Charter school
 Private school – religious
 Private school – nonsectarian
 * After school program








* Home school setting
* Pre-school
* Summer program/camp
* Correctional facility
* Rehabilitation center or hospital
* Community center
* Tutoring for a “for profit” company
* Other: _______________________________________
Applicant’s Role at the Proposed Setting.
 Paid Employee – Full time
 Paid Employee – Part time
 Long term substitute. Length of contract: ____________________________
 Unpaid Volunteer
 Other ________________________________________________________(specify)
*****************************************************************************************************************************************************************
Only answer the following if your Proposed Setting Type (above) is not a traditional 5-day/week classroom setting in the Fall/Spring term.
Dates & Hours of Service at the Proposed Setting.
Starting Date __________________ (mm/dd/year)
Ending Date __________________ (mm/dd/year)
Total weeks of instruction: __________________________________________ (calculate above info)
Number of instructional hours per week________________________________
Number of students in proposed instructional group: _____________________
CGU Teacher Education Application; revised April 2012
page 9
CLAREMONT GRADUATE UNIVERSITY
ADDITIONAL REQUIRED FORMS. For Teacher Education Programs Only.
________________________
FOR OFFICE USE ONLY
FINANCIAL AID APPLICATION FORM
FOR CGU’s TEACHER EDUCATION APPLICANTS ONLY
EDUCATIONAL FINANCING (Please advise CGU of your plans for and interests in financing your education.)
 Please consider me for CGU departmental financial support in the form of Fellowship, Research/Teaching Assistant Positions, and Stipends.
(Fill out information below.*)
 Please consider me for Minority Aid. (Fill out information below.*)
 I have/will apply (or have applied) for Federal Student Aid using the FAFSA (Free Application for Federal Student Aid at www.fafsa.ed.gov**).
o
** CGU’s institutional code for the FAFSA is G01169.
 I will be sponsored by my company or government to be assisted in or reimbursed for my educational costs.
 I am not applying for financial aid from CGU.
U.S. Citizens and Permanent Residents: To apply for Federal Financial Aid, please complete the Free Application for Federal Student Aid (FAFSA)
found at www.fafsa.ed.gov**. The priority deadline to be considered for federal work-study is March 2 for those entering in the fall term.
** CGU’s institutional code for the FAFSA is G01169.
Third-Party Support or Company Reimbursement
Sponsor or Company:
_________________________________________________________________________________________________________________________
Amount and terms of support:
_________________________________________________________________________________________________________________________
*****************************************************************************************************************************************************************
Only answer the following if you are asking for Departmental or Minority Aid.
Request for Fellowship/Departmental Aid
Please complete the sections below to the best of your ability; estimate for future projections based on your expected financial situation while attending
CGU. Decisions about admissions and institutional financial support are made independently of each other. Information contained in this form and its
attachments, if any, WILL NOT influence the admission decision. The information you provide is confidential and will not be shared with third parties
outside CGU without your permission except in anonymous statistical form. Please be sure to attach separate sheets of paper to describe any special
circumstances that would help us when considering financial support for you.
Family Information
Number and ages of dependents (excluding self and spouse): _______________________________________________________________
In your household, how many persons, including self and spouse, are dependent upon income and assets shown below? ________________
Income Information (use annual figures)
previous year
current year
next year (projected)
Self (employment gross income)
$ ______________________ $ ______________________ $____________________
Spouse
$______________________ $ ______________________ $____________________
Other income
$ ______________________ $ ______________________ $____________________
Specify source of other income: _______________________________________________________________________________________
Expense Information (use annual figures)
previous year
current year
next year (projected)
Rent or mortgage
$ ______________________ $ ______________________ $ ____________________
Fixed Expenses
$ ______________________ $ ______________________ $ ____________________
(expenses that will remain the same regardless of your income or where you live, e.g. loan payments,
utilities, alimony, child support, car payment)
Other Expenses
$ ______________________ $ ______________________ $ ____________________
Asset Information (current value) Applicant and Spouse (if applicable)
Cash, savings, certificates $ _________________________________________________________________________________________
Investments (e.g. stocks, bonds, trusts) $ _______________________________________________________________________________
Home and other real estate equity (if you rent, write Ø) $ ___________________________________________________________________
Trust Funds $ _____________________________________________________________________________________________________
Financing Your Previous Education
Monthly payments on undergraduate loans: _________________ Total borrowed: _________________ Balance remaining: ______________
Monthly payments on graduate loans: ______________________Total borrowed: _________________ Balance remaining: ______________
CGU Teacher Education Application; revised April 2012
page 10
CLAREMONT GRADUATE UNIVERSITY
Optional Admissions Survey
________________________
FOR OFFICE USE ONLY
Applicant Last/Family Name: __________________________________________ Applicant First Name: _____________________________________
Applicant Date of Birth: __________- __________- __________ Email Address: _________________________________________________________
Semester for which I am applying:
Fall of 20_______
Spring of 20 _______
Summer of 20 _______
Academic program to which I am applying: ______________________________________________________________________________________
Your response in the following sections is voluntary and confidential and will only be used for statistical purposes. It will not impact the
status of your application.
I am the first person in my family to pursue a graduate education:
Yes
No
I may need special services to accommodate a physical, perceptual, or learning disability:
Yes
No
I am a US Veteran:
Yes
No
Yes
No
I am currently serving in the US Armed Forces:
If yes:
Branch Serving: __________________________ Rank: _____________________________ Status:
Anticipated End Date of Duty: _______________
Active Duty
Reserve
Ethnicity and Race (for US Citizens and US Permanent Residents)
I identify with the following ethnicity/race (Please select only one.):
_____ Hispanic/Latino(a)
_____ Not Hispanic/Latino(a)
Furthermore, I identify with the following: (Select all with which you identify.)
_____ American Indian or Alaska Native
_____ Asian
_____ Black or African American
_____ Native Hawaiian or Other Pacific Islander
_____ White
The following people and/or resources influenced my decision to apply to CGU.
CGU faculty member. Who? ____________________________________________
CGU staff member. Who? ______________________________________________
Current CGU student. Who? ____________________________________________
CGU alumna or alumnus. Who? _________________________________________
Claremont Colleges faculty, staff or alum. Who? _____________________________
Faculty member at your institution. Who? __________________________________
Other graduate school reference/guide. Which? _____________________________
Other. Please specify: _________________________________________________
_______________________________________________________________________
Newspaper advertisement. Which paper? __________________________________
Radio advertisement. Which station? ______________________________________
Other CGU promotional materials. Which? _________________________________
(50)
(58)
(51)
(52)
(53)
(55)
(10)
Your employer/co-worker (57)
Family or friends (56)
GRE/GMAT locator service (20)
GRE/GMAT forum (23)
CGU visit to your company/campus.
Which site? _______________________(24)
CGU website (33)
Peterson’s Guide (13)
(98)
(28)
(32)
(27)
Below is my rating of various factors in my consideration of CGU. I have circled my choices.
Reputation of faculty
Reputation/quality of the academic department
CGU’s overall reputation
Location
Flexibility of curriculum
Personal contact with CGU faculty and/or staff
Quality of academic facilities
very important
1
2
1
2
1
2
1
2
1
2
1
2
1
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
not important
5
5
5
5
5
5
5
not applicable
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Graduate-only institution
Responsiveness to your inquiry
Membership in the Claremont Colleges Consortium
CGU career services
Diversity of faculty and student body
Visit to campus
Influence of undergraduate advisor
1
1
1
1
1
1
1
2
2
2
2
2
2
2
3
3
3
3
3
3
3
4
4
4
4
4
4
4
5
5
5
5
5
5
5
N/A
N/A
N/A
N/A
N/A
N/A
N/A
If admitted, how important will the availability of
Fellowship aid be in your decision to attend CGU?
1
2
3
4
5
N/A
Other colleges/universities to which I am
applying:__________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
Signature: __________________________________________________________________________ Date: ________________________________
CGU Teacher Education Application; revised April 2012
page 11