Graduate Programs in Industrial Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 APPLICATION FOR ADMISSION MASTER OF SCIENCE PROGRAM TECHNOLOGY ENGINEERING MANAGEMENT (Please type or print in ink) Name: First Middle Social Security Number: - Last - 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: (3T9) Non Thesis (3T9) Thesis On Line On Campus Are you interested in an assistantship? Yes No If yes, have you attached the application for a graduate assistantship? Yes No Please list the three individuals you have asked to submit professional references in support of your application for admission to the graduate program. 1. Name Position Address City State Position Address City State Position Address City State Zip 2. Name Zip 3. Name Zip 1/3 Graduate Programs in Industrial Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 College and 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 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. Source of Program Awareness: Identify the initial source which made you aware of our graduate program and prompted your inquiry or application. Poster Advertisement Faculty Referral UNI Catalog Communication of Career Goals: In order to make the faculty admission committee aware of your desired professional goals and aspirations, you are asked to respond to the following questions on the application form. Your ability to communicate clearly and effectively in written form will be reviewed with regard to writing style and mechanics. 2/3 Graduate Programs in Industrial Technology at The University of Northern Iowa Cedar Falls, Iowa 50614 1. 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? Answer: 2. 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? Answer: 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. P:\ITC Dept\Grad Prog\Grad Forms\ms application.doc Revised 5/12/14 3/3