Brandeis University Graduate School of Arts and Sciences | Admission Application GSAS requires that you fill out all required fields marked with an * and include all required documents when submitting the application. Application requirements are listed at http://www.brandeis.edu/gsas/programs. The fee for paper applications is $75. You will receive a payment-required email notification once your application information has been entered electronically. *Personal Information *First Name | Middle Name | *Last Name | Other Last (Family) Name Used | Permanent Address: *Country | *Address 1 | Address 2 | *City | *State | *Postal Code | Mailing Address: Check here if Mailing and Permanent Address are the same *Country | *Address 1 | Address 2 | *City | *State | *Postal Code | Preferred Telephone | *Email Address | *Sex | Female Ethnic Group | Work Home Mobile (example: johnsmith@company.com) Male Gender Identity | Woman Transgender Man Another Identity Format (MM/DD/YYYY) *Date of Birth | Black or African American (including Africa and Caribbean) American Indian or Alaska Native Native Hawaiian or Other Pacific Islander White (including Middle Eastern) *Citizenship Country | Hispanic or Latino Asian (including Indian subcontinent and Philippines) *Dual Citizenship Country | If you are a non-U.S. citizen, are you a permanent resident of the U.S.? | No Indicate additional languages spoken and corresponding language level below. | What is your native or first language? | Foreign Language 1 | Speaking Proficiency | Yes Foreign Language 2 | Low Moderate High Speaking Proficiency | Low Moderate High Reading Proficiency | Low Moderate High Reading Proficiency | Low Moderate High Writing Proficiency | Low Moderate High Writing Proficiency | Low Moderate High Listening Proficiency | Low Moderate High Listening Proficiency | Low Moderate High 1 * *Program Information Program Details Degree Type | Program | Concentration (if applicable) | Entry Term | Registration Status | Full-time Spring Summer Fall Year | Part-time Other Information Have you ever applied to the GSAS in the past? | Yes No Are you interested in being considered for a Schusterman Center fellowship if applicable? Details can be found here: www.brandeis.edu/israelcenter/support/doctoral.html? | Yes Do you wish to be considered for financial assistance? | Yes No If applicable, do you wish to express interest in the Brandeis IGERT program in the theoretical/mathematical sciences (www.brandeis.edu/igert/)? Funding is available for US citizens and permanent residents. | No Yes No Faculty Information It is helpful for the admission committee to know which faculty at Brandeis are currently undertaking research in areas that interest you. Please list up to four individuals. Visit www.brandeis.edu/gsas/admissions/apply/departmentalfaculty.html for more detailed information on their interests. Name | Specialty | Name | Specialty | Name | Specialty | Name | Specialty | *Recommendation Information Provide information for the required number of persons writing letters of recommendation on your behalf. Recommenders must submit their letter to the Graduate School of Arts and Sciences in a sealed envelope via postal mail (GSAS Brandeis | 415 South St, MS 31 | Waltham, MA 02454) or via electronic mail (gradschool@brandeis.edu). Applicants are responsible for contacting recommenders and providing them with this information. The Family Educational Rights and Privacy Act of 1974 (Buckley Amendment) allows you to access your educational records if you enroll at Brandeis University. For each recommendation letter below, you may waive your right of access to the specific report if you so choose. Please indicate whether you do waive your right of access for each recommendation letter that you list. Your decisions to waive or not to waive your right of access will have no bearing on the handling of your application. Recommendation Provider #1 I waive I do not waive First Name | Last Name | Title | Organization | Recommendation Provider #2 I waive I do not waive First Name | Last Name | Title | Organization | Recommendation Provider #3 First Name | I waive I do not waive Last Name | Title | Organization | 2 *Educational Record List all institutions where you enrolled in post-secondary coursework with the exception of institutions where the courses and/or credits were transferred to another institution that you have listed (e.g., study abroad). “Undergraduate Institution” must be where you received your bachelor’s degree. You must provide official transcripts of all insitutions listed. If you attended more than four schools, include the most relevant institutions on this form, but submit transcripts from all. Undergraduate Institution | Country | City, State | Major | Dates Attended | Degree | (MM/YY-MM/YY) Degree Date | Institution | Country | City, State | Major | Dates Attended | (MM/YY-MM/YY) Degree Date | Degree | Institution | Country | City, State | Major | Dates Attended | (MM/YY-MM/YY) Degree Date | Degree | Institution | Country | City, State | Major | Dates Attended | (MM/YY-MM/YY) Degree Date | Degree | Institution | Country | City, State | Major | Dates Attended | (MM/YY-MM/YY) Degree Date | Degree | *Test Scores You may enter your unofficial test scores below, but are required to submit official test score reports for all scores required for your application. For more details on which test scores are required for application, please visit http://www.brandeis.edu/gsas/programs/index.html. Graduate Record Examination General (GRE General) Verbal | %| Test Date | Quantitative | %| Graduate Record Examination Subject (GRE Subject) Subject Score | Scholastic Assessment Test (SAT) Test Date | Science Reasoning | %| English Language Proficiency Exam Total or OBS Score | Listening | IELTS English | Writing | English/Writing | Total | %| Quantitative | TOEFL Intended Major % | %| Composite | Graduate Management Admission Test (GMAT) Test Date | Verbal | Essay Subscore | Total Score | Test Date | Reading| Math | Writing | Math | American College Testing (ACT) %| Combined | Test Date | Critical Reasoning | %| Test Date | Component | Miller Analogies Test (MAT) Analytical Writing | PTE Reading | 3 %| Integrated Reasoning | AWA | %| %| Test Date | Writing | Speaking | *Additional Information I was or currently am, a member of any of the following: Institute for Recruitment of Teachers AmeriCorps Annual Biomedical Research Conference for Minority Students McNair Scholars Program Brandeis Alumnus Peace Corps Brandeis Current Student Brandeis Employee Science Without Borders City Year Teach for America Consortium School: Tufts, BC, BU, Wellesley DAAD Exchange Scholar The Posse Foundation (www.possefoundation.org) Fulbright Program / IIE / Amideast United States Military Wheaton Colllege Literary and Cultural Studies Were you a first-generation college student when you attended your undergraduate institution? | Amideast If you will receive funding from any of the following sources for part or all of your tuition, please select the appropriate funder. Yes No Foreign Government Fulbright / IIE (Institute for International Education) If you have been given an application code, please enter it here: | U.S. Armed Forces status: | Currently Dependent Currently Serving No Relation Previously Served To better serve our student population, we are interested to learn of other institutions to which you may have applied. Institution | Program | Institution | Program | Institution | Program | Institution | Program | Institution | Program | How did you learn about the GSAS program to which you are applying? Member of the Brandeis Community Advertisement Advisor at your undergraduate institution Other Service Organization Education USA Office Graduate School Fair Email from Brandeis GSAS Digital/Social Media Employer 4 Fulbright or Overseas Advisor Gradschools.com Petersons.com The Princeton Review *Personal Disclosure Questions Do you have any criminal charges pending against you or any open arrest warrants? Yes No Have you ever been convicted of any criminal offense other than 1) a misdemeanor more than five years ago, or 2) a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray, or distrubance of the peace? Yes No If you answered yes to either question above, please explain on a separate page and include the explanation when you mail your application. *Signature Brandeis University is a community of scholars dedicated to research, academic excellence, the pursuit and cultivation of new knowledge, and the robust intellectual exchange among faculty and students. In support of this mission, every member of the University - student, faculty, other academic appointees, and staff - makes a commitment to strive for personal and academic integrity; to treat others with dignity and respect; to honor the rights and property of others; to take responsibility for individual and group behavior; and to act as a responsible citizen in a free academic community and in the larger society. Any student conduct, on or off campus, of individuals or groups, that threatens or violates this commitment may become a matter for action within the University's system of student discipline. The University expects a student who has accepted admission but who has not yet assumed the role of a student at the University to have made the same commitment. Admission may be deferred or revoked for fraud, misrepresentation, material omission of fact, dishonesty, violation of University standards in the application for admission, violation of University academic standards, or any other pre-matriculation misconduct. By signing below you signify that ALL of the information you have provided in your application is truthful, complete and accurate, and that all of the material that you have submitted as your own work, in fact, is entirely your own work. I certify that the information that I have provided in my application is truthful, complete and accurate, and that all of the material that I have submitted as my own work, in fact, is entirely my own work. By signing you attest that all of the information you are providing is true to the best of your knowledge and you understand and agree that Brandeis University reserves the right to deny admission or permission to register or require the withdrawal of any student at any time for any reason it considers sufficient, including but not limited to character and personal conduct. Date Signature *Application Completion Please review your application carefully to ensure that you have completed all of the required sections and questions. If you do not fill out the required questions in their entirety, this will result in significant delays in the processing of your application. Please visit www.brandeis.edu/gsas/programs/index.html to determine what additional materials you need to submit with your application (e.g., statement of purpose, resume/CV, writing sample, etc.). All of your application materials should be sent in one package to: Graduate School of Arts and Sciences | 415 South Street, MS 31 | Kutz 219 | Waltham, MA 02454 Should you have any questions you can reach the Graduate School of Arts and Sciences Admissions Office at gradschool@brandeis.edu or (781) 736-3410. 5