Application Template
Please read the application instruction packet carefully before you
begin constructing your template. Feel free to copy and paste your
work into this document or create your own. Keep in mind the
following documents must be included, in this format and bundled
into one singular MS Word or PDF document.
Include the following:
1. Resume
2. Writing Sample
3. Application Questions
4. Prerequisite Documentation
5. Self-Disclosure Statement
6. Petition for Exceptional Consideration
Next you will upload your template in your eApp under the
additional uploads option. Please send a backup to swdirect@iu.edu
to ensure we receive your template.
Resume
Writing Sample
Application Questions
Prerequisite Documentation Form
Enter the course information below
SocialBehavioral
Sciences
Course Title
Course
number
Institution Attended
1.
2.
3.
4.
5.
6.
Statistics
Enter your computed GPA Here: ______
Describe any unusual issues or circumstances below.
Term
If not
Completed completed,
i.e. Fall 2014 date planned
SELF-DISCLOSURE STATEMENT
This form must be completed and submitted by EVERY applicant and is
included in the template.
Please place an ‘X’ or BOLD your answers.
Yes No 1. Are you, or have you ever been the subject of any disciplinary proceedings while
attending any college, university, or other post-high school educational program?
☐ ☐
Yes No 2. Have you ever been convicted of any violation of law, or are there any charges
pending against you? (Include all criminal offenses, i.e., felonies and
☐ ☐
misdemeanors.)
Yes No 3. Are you or have you ever been the subject of any disciplinary proceedings by any
professional organization?
☐ ☐
Yes No
☐ ☐
If yes to question #2, do you wish to appeal to the School of Social Work’s Policy on
Sex Offenses? For a copy of the policy, please see Admission Policies Applicable to
IUSSW applicants in this document.
If you have answered “Yes” to any of the questions, you must provide a personal statement
of explanation giving full details and an explanation of the event. Your personal statement
should be included with your “disclosure” file. Also, include the facts and the disposition of
the case. Please be advised that answering “Yes” to any of the above questions does not
automatically disqualify your application. In addition, it is also appropriate to discuss
significant issues disclosed here in your application questions.
Petition for Exceptional Consideration