Graduate Programs in Department of Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 APPLICATION FOR ADMISSION DOCTOR OF INDUSTRIAL TECHNOLOGY PROGRAM (Please type or print in ink) Name: Last First Social Security Number: - Middle Preferred Entering Date: - Fall Semester, August 20 Spring Semester, January 20 Summer Session, June 20 UNI Student Number: Present Address: City State Telephone Number: ( ) - Zip Country Until What Date: Permanent Address: City Telephone Number: ( State ) - Zip Country Email Address: Are you interested in an assistantship? Yes No If yes, have you attached the application for a graduate assistantship? Yes No Graduate Record Examination is required for admission. Date you took the GRE: Please list the three individuals you have asked to submit professional references in support of your application for admission to the graduate program. 1. 2. 3. Name Name Name Position Address City State Position Address City State Position Address City State Zip Zip Zip 1/5 Graduate Programs in Department of Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 College & University Experience: Please list, in reverse chronological order (most recent first), all colleges and universities attended. Dates Attended Degree, if any, School Location Major Subject From To and Year Received Professional Experience: Please list, in reverse chronological order, employment (including summer work) or military service since secondary school. Please include validation for the number of years of related and significant work experience as required for the degree. Dates Employer Position Part or Full-time From To P/T F/T P/T F/T P/T F/T P/T F/T P/T F/T P/T F/T Extracurricular/ Community Activities: Please list, in order of importance to you, your major extracurricular and community activities in college and since baccalaureate graduation. Dates Offices Held, Distinctions, Activity From To Awards, Etc. --------------------------------------------------------------------------------------------------------------------Technology Issues, Career Goals, Special Qualifications: The Graduate Admissions Committee will assess this ability and will use it as ONE source of information in evaluating your application for admission. Some factors that will be used in evaluating your responses are a) organization and content, b) writing style and mechanics, c) expression of ideas, and d) congruency of rationale. The Department of Technology Graduate Admissions Committee asks that you respond to the following questions only in the space provided and in your own handwriting. 2/5 Graduate Programs in Department of Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 1. Describe what you perceive as a major issue or problem relative to the discipline of industrial technology. Include your reasons for selecting the issue or problem. 3/5 Graduate Programs in Department of Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 2. What are your career goals in relationship to the field of industrial technology, and why do you perceive the attainment of this graduate degree as appropriate to your career goals? 4/5 Graduate Programs in Department of Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 3. Explain what there is about your personality and unique knowledge and skills that lead you to believe that you can complete a doctoral program successfully. 4. Describe your technical expertise which has been developed in your educational, laboratory, and professional experiences. How do you envision furthering, expanding, and/or establishing your technical expertise? In addition to the above responses, you may wish to submit one or two representative items of previously written materials that would provide the Graduate Admissions Committee with evidence of your writing ability. These may include: a) journal or magazine articles, b) term papers or reports from previous educational experiences, or c) technical reports, project reports, or other materials produced in various occupational roles. Supplementary materials which you supply will be returned to you as soon as a decision on your application is completed. All International students should return materials to: Linda Jernigan, University of Northern Iowa, Admissions Office- GIL 0002, Cedar Falls, IA 50614-0018. All other applicants please return this application and all other materials to: Laurie Russell, Record Analyst, UNI Admissions Office, Gilchrist 002, Cedar Falls, IA 50614-0018. Revised 4/30/13 5/5