Texas Woman’s University
COMS Department Application Form – SLP Pre-Master’s Leveling Program
Deadline: October 1 for classes beginning in January
Name: (Please Print) _________________________________________________ Last 4 digits SS#___________________
Address:___________________________________________________________________________________________
City_______________________________________________State_______________________Zip__________________
Email address:________________________________________________________________
Phone numbers: _______________________________ (home) ____________________________________ (cell)
University granting bachelor’s degree: ________________________________________________
Date of graduation: ___________________________ Cumulative GPA: ________________________________
Please initial to indicate your understanding of the following requirements:
______ The TWU SLP Pre-Master’s Leveling Program is offered for students who wish to apply to the TWU SpeechLanguage Pathology Master’s Program (either the on-campus or distance venue). If accepted into the TWU SLP PreMaster’s Leveling Program, I plan to apply to (please check):
_______On-Campus SLP Master’s venue
_______Distance SLP Master’s venue
______ I understand that my final exams will be taken on the Denton TWU campus if I am applying to the On Campus
venue OR at one of the Education Service Centers (not necessarily the one closest to me) if I am applying to the distance
venue.
______ The TWU SLP Pre-Master’s Leveling Program is NOT a licensed assistant preparation program and completion of
the Program does NOT fulfill the requirements for an “Assistant in Speech-Language Pathology” license.
______ Admission to the TWU SLP Pre-Master’s Leveling Program is competitive and enrollment is limited, and my
application is NOT a guarantee of admission.
______ Admission to the TWU SLP Pre-Master’s Leveling Program does NOT constitute or ensure acceptance into the
TWU Master’s Program in Speech-Language Pathology.
______ Courses in the TWU SLP Pre-Master’s Leveling Program are offered within a specific time period for each
entering cohort, and I must enroll in the specified courses at the time and in the sequence they are offered.
______ I must maintain an A or a B in all TWU SLP Pre-Master’s Leveling Program courses in order to be allowed to
continue. If I earn a grade of C or lower in a TWU SLP Pre-Master’s Leveling course, I understand that I may retake the
course only one time and that I must earn a grade of A or B before I can enroll in any further TWU SLP Pre-Master’s
Leveling courses. If I earn a second C (or lower) in the same or different course, I will not be allowed to continue in the
TWU SLP Pre-Master’s Leveling Program.
My signature below indicates my acceptance of the above terms and my intention to apply to the TWU graduate SLP
program and participate in this year’s TWU SLP Pre-Master’s Leveling Program.
__________________________________________________________________
Signature of Applicant
__________________________
Date
*Mail this application, two sealed Pre-Master’s Leveling Program recommendation forms, and letter of intent to:
TWU Dept. of COMS
P. O. Box 425737
Denton, Texas 76204-5737
Attn: Pre-Master’s Leveling Program Coordinator
NOTE: Applicants must also apply to Texas Woman’s University as a Transfer Non-Degree Student (www.twu.edu/admissions)
Rev. 4/18/16
Request for Recommendation
Texas Woman’s University SLP Pre-Master’s Leveling Program
NAME OF APPLICANT (PLEASE PRINT):____________________________________________________________________________
APPLICANT’S FULL MAILING ADDRESS: __________________________________________________________________________
________________________________________________________________________________________________________________
APPLICANT’S PHONE NUMBER: ______________________________________________
LAST 4 DIGITS OF SS#:___________
The above applicant is applying for admission to the TWU Pre-Master’s Leveling Program for speech-language
pathology. Both the applicant and the program would appreciate your completing this form and returning it to the
applicant in a sealed envelope signed across the back flap. If you would like to write a letter in addition to this
form, please feel free to do so. If you prefer, you may mail the form directly to TWU SLP Pre-Master’s Leveling
Program Coordinator, TWU - COMS, P.O. Box 425737, Denton, TX 76204.
In compliance with the federal privacy right of parents and students (Buckley amendment), any recommendation or
letter (that becomes a part of the record for enrolled students) will be available to the student, unless the student
has signed a waiver of the student’s right of access. If you wish to waive your right of access to this letter,
applicant please sign below.
I hereby waive my right of access to this recommendation: _____________________________________________________
KNOWLEDGE OF THE APPLICANT
1. APPROXIMATELY HOW LONG HAVE YOU KNOWN THE APPLICANT? ____________________YEARS ____________________MONTHS
2. HOW WELL DO YOU FEEL YOU KNOW THE APPLICANT?
CASUALLY
3. WHAT IS/WAS THE NATURE OF YOUR CONTACT WITH THE APPLICANT?
COLLEGE INSTRUCTOR IN MORE THAN ONE CLASS
WELL
VERY WELL
COLLEGE INSTRUCTOR IN ONE CLASS
IMMEDIATE SUPERVISOR
CO-WORKER
OTHER (SPECIFY) ___________________________________________________________________________________________________
COMPARING THIS APPLICANT TO OTHER COLLEGE GRADUATES, PLEASE RATE THE APPLICANT AS FOLLOWS.
No opportunity to
observe or N/A
Below
Average
Average
Good
Very
Good
Outstanding
Academic performance
Flexibility
Written expression
Oral communication skills
Ability to work with others
Reliability/Dependability
Initiative/Self-reliance
Motivation/Perseverance
Judgment/Common sense/Emotional maturity
Organization/Time management
Stress management
Ability to accept & benefit from constructive
criticism
This form was completed by__________________________________________ Date: _________________
(Page 1 of 2)
Rev. 4/18/16
Please add any additional information you think would be helpful to us as we make our decision (you may
attach a separate letter).
Regarding the program to which the candidate has applied, you would:
____Recommend admission strongly
____Recommend admission
____Recommend admission with reservations
____Not recommend admission
_______________________________
Name
(print)
____________________________________
Signature of Respondent
_______________________________
Title
____________________________________
Date
_______________________________
Affiliation
Address of Respondent:
___________________________________
____________________________________
(Page 2 of 2)
Rev. 4/18/16
Request for Recommendation
Texas Woman’s University SLP Pre-Master’s Leveling Program
NAME OF APPLICANT (PLEASE PRINT):____________________________________________________________________________
APPLICANT’S FULL MAILING ADDRESS: __________________________________________________________________________
________________________________________________________________________________________________________________
APPLICANT’S PHONE NUMBER: ______________________________________________
LAST 4 DIGITS OF SS#:___________
The above applicant is applying for admission to the TWU Pre-Master’s Leveling Program for speech-language
pathology. Both the applicant and the program would appreciate your completing this form and returning it to the
applicant in a sealed envelope signed across the back flap. If you would like to write a letter in addition to this
form, please feel free to do so. If you prefer, you may mail the form directly to TWU SLP Pre-Master’s Leveling
Program Coordinator, TWU - COMS, P.O. Box 425737, Denton, TX 76204.
In compliance with the federal privacy right of parents and students (Buckley amendment), any recommendation or
letter (that becomes a part of the record for enrolled students) will be available to the student, unless the student
has signed a waiver of the student’s right of access. If you wish to waive your right of access to this letter,
applicant please sign below.
I hereby waive my right of access to this recommendation: _____________________________________________________
KNOWLEDGE OF THE APPLICANT
1. APPROXIMATELY HOW LONG HAVE YOU KNOWN THE APPLICANT? ____________________YEARS ____________________MONTHS
2. HOW WELL DO YOU FEEL YOU KNOW THE APPLICANT?
CASUALLY
3. WHAT IS/WAS THE NATURE OF YOUR CONTACT WITH THE APPLICANT?
COLLEGE INSTRUCTOR IN MORE THAN ONE CLASS
WELL
VERY WELL
COLLEGE INSTRUCTOR IN ONE CLASS
IMMEDIATE SUPERVISOR
CO-WORKER
OTHER (SPECIFY) ___________________________________________________________________________________________________
COMPARING THIS APPLICANT TO OTHER COLLEGE GRADUATES, PLEASE RATE THE APPLICANT AS FOLLOWS.
No opportunity to
observe or N/A
Below
Average
Average
Good
Very
Good
Outstanding
Academic performance
Flexibility
Written expression
Oral communication skills
Ability to work with others
Reliability/Dependability
Initiative/Self-reliance
Motivation/Perseverance
Judgment/Common sense/Emotional maturity
Organization/Time management
Stress management
Ability to accept & benefit from constructive
criticism
This form was completed by__________________________________________ Date: _________________
(Page 1 of 2)
Rev. 4/18/16
Please add any additional information you think would be helpful to us as we make our decision (you may
attach a separate letter).
Regarding the program to which the candidate has applied, you would:
____Recommend admission strongly
____Recommend admission
____Recommend admission with reservations
____Not recommend admission
_______________________________
Name
(print)
____________________________________
Signature of Respondent
_______________________________
Title
____________________________________
Date
_______________________________
Affiliation
Address of Respondent:
___________________________________
____________________________________
(Page 2 of 2)
Rev. 4/18/16