SENECA MSW@USC APPLICATION ADVANCED STANDING
STEP 1: SUPPLEMENTAL APPLICATION FORM
APPLICATION PROCESS
STEP
STEP
STEP
STEP
STEP
1:
2:
3:
4:
5:
Complete this Supplemental Application Form
Recommendations (Start this as soon as possible.)
Attach all unofficial transcripts to Supplemental Application Form
Attach personal statement to Supplemental Application Form
Submit all required documents to SenecaMSW-USC@senecacenter.org or mail to
Seneca MSW@USC Review Team, 6925 Chabot Road; Oakland, CA 94618
APPLICANT INFORMATION
First Name:
Last Name:
Middle Name:
Current home address:
City:
State:
ZIP Code:
Email address:
Phone:
Alternate Phone:
Semester for which you wish to apply: January 2016
ACADEMIC BACKGROUND
Cumulative GPA:
Cumulative Graduate GPA (if applicable):
Are you applying for advanced standing? (BSW is required)
Combined GPA for all social work courses:
Yes
No
(Must be at least 3.5 to qualify)
List any publications you have authored or co-authored, and any academic honors, awards or scholarships you
have received:
Have you ever been the subject of disciplinary action at any college or university?
(Examples of disciplinary action include: Plagiarism, Academic probation, etc.)
Yes
No
If yes, what were the circumstances?:
High School
Name of school at which you earned your high school diploma:
City:
State:
Country:
High School Graduation Date:
High School Dates of Attendance:
NOTE: Please list any and all colleges/universities that you have attended, including semesters abroad. You
need to submit unofficial transcripts from every school to Seneca. If you are recommended to the program by
the Seneca review team, USC requires that you submit official transcripts from every college/university you
have attended. Some schools have processing times for requesting official transcripts, so please plan
accordingly.
College/University
#1
College/University
#2
Name of College or University:
City:
State:
Country:
Dates of Attendance:
Degree Received/ Expected:
Name of College or University:
City:
State:
1
Country:
STEP 1: SUPPLEMENTAL APPLICATION FORM
Dates of Attendance:
College/University
#3
College/University
#4
College/University
#5
Degree Received/ Expected:
Name of College or University:
City:
State:
Country:
Dates of Attendance:
Degree Received/ Expected:
Name of College or University:
City:
State:
Country:
Dates of Attendance:
Degree Received /Expected:
Name of College or University:
City:
State:
Country:
Dates of Attendance:
Degree Received/ Expected:
TEST INFORMATION – (OPTIONAL)
Graduate Record Examination (GRE) - If you have taken the GRE multiple times, please report the best score
received in each skill category. Note the GRE is not required for admission. If you did not take the GRE, leave
this section blank.
GRE Date (most recent):
Best Verbal Score:
Best Verbal Percentile:
Best Quantitative Score:
Best Quantitative Percentile:
Best Analytical Writing Score:
Best Analytical Writing Percentile:
Best Cumulative Score:
Best Cumulative Percentile:
GRE Subject Date:
Subject:
Subject (Advanced) Score:
Subject (Advanced) Percentile:
Additional Tests Already Taken - List any other tests you have taken. (Ex: TOEFL, etc.)
Additional Test #1:
Date Taken:
Score:
Percentile:
Additional Test #2:
Date Taken:
Score:
Percentile:
Additional Tests Planned
Name of Test:
Date:
Name of Test:
Date:
LANGUAGE BACKGROUND
Native or First Language (Optional):
Competency in a Language other than English #1:
Indicate proficiency in:
Reading:
-Fluent
-Moderate
-Excellent
-Minimal
Writing:
-Fluent
-Moderate
Language #2:
2
-Excellent
-Minimal
Speaking:
-Fluent
-Moderate
-Excellent
-Minimal
STEP 1: SUPPLEMENTAL APPLICATION FORM
Indicate proficiency in:
Reading:
-Fluent
-Moderate
-Excellent
-Minimal
Writing:
-Fluent
-Moderate
-Excellent
-Minimal
Speaking:
-Fluent
-Moderate
-Excellent
-Minimal
Computer Languages
Please list any computer languages you have working experience with.
ADDITIONAL QUESTIONS
Did your parents or siblings attend USC?
Yes
No
Are you the first generation to attend college?
Yes
No
Are your parents or spouse employed by USC?
Yes
No
Please tell us how you first learned of the program you are applying to:
Research Topics
Please list two or three scholarly/research topics that are especially interesting to you.
Faculty
Please list names of two or three faculty members whose research you find most interesting and with whom
you wish to work during your graduate studies.
3
STEP 1: SUPPLEMENTAL APPLICATION FORM
Research Experience
Describe your pertinent research experience, training and publications. For your research experience, please
describe in your own words the overall goals, your role in the r esearch project, whether you worked
independently or part of a group and the overall results that you obtained. For publications, please provide the
complete reference information that would be included in a scientific journal such as Science, Nature or Ce ll.
Honors and Awards
Please list any post secondary (college level) academic and/or service awards you received.
MSW PROGRAM QUESTIONS
Campus: Virtual Academic Center ONLY
Program Length:
4 Semesters
Please indicate your desired cohort date: January 2016 (Spring)
Are you applying to other MSW programs:
Yes
No
If yes, please specify the schools in the space provided below.
Are you applying to a graduate program other than Social Work?
If yes, please specify which ones in the space provided below.
Have you attended another MSW Program?
Yes
No
If yes, please specify the school in the space provided below.
4
Yes
No
RECOMMENDATIONS
Your application is not considered complete until at least two recommendation letters are received.
Each recommendation must include a letter of recommendation AN D the supplemental recommendation form.
Both the recommendation letter and the form must be directly emailed from the recommender to the Seneca
review team at:
SenecaMSW-USC@senecacenter.org or
directly mailed in a sealed envelope, with the recommender’s signature across the seal, to:
Seneca MSW@USC Review Team
6925 Chabot Road
Oakland, CA 94618
A total of two recommendations (one professor from your BSW degree program and one supervisor from your
BSW fieldwork experience) are required for this application to be considered complete. A third
recommendation is optional.
Applicants are responsible for completion of the “applicant information” section, recommender’s names,
contacting all references, providing them with all reference materials, and ensuring that all required documents
are submitted to Seneca within two weeks of submittal.
Please see separate letter of recommendation form and send the request form to your recommenders as soon
as possible. Each recommendation letter must come directly from your recommender.
List information about your recommendations below.
Recommendation
#1: BSW Professor
Recommendation
#2: BSW Fieldwork
Supervisor
Recommendation
#3:
(Optional)
Relationship to you:
Name:
Email Address:
Phone:
Title:
Employer:
Relationship to you:
Name:
Email Address:
Phone:
Title:
Employer:
Relationship to you:
Name:
Email Address:
Phone:
Title:
Employer:
5
APPLICATION DOCUMENTS CHECKLIST
STEP 1:
Application Completed
Attached
STEP 2a:
Recommendation#1 (BSW Professor)
Emailed/Mailed directly
from Recommender
STEP 2b:
Recommendation#2 (Fieldwork Supervisor)
Emailed/Mailed directly
from Recommender
STEP 2c:
Recommendation#3 (Optional)
Emailed/Mailed directly
from Recommender
STEP 3:
All College Transcripts
(unofficial transcripts accepted)
Attached
STEP 4:
Statement of Purpose (see prompt)
Attached
STEP 5:
Submit all the documents; must be sent within two weeks from the day you received notice to
submit.
AUTHORIZATION
I hereby certify that the above statements are true and cor rect to the best of my knowledge
and agree to have any of the statements checked by Seneca Family of Agencies (SFA). I
authorize the references listed above, as well as all other individuals whom SFA contacts, to
provide the SFA review team any and all information concerning my current or previous
employment, academic success, and any other pertinent information that they may have
including agency personnel files and performance evaluations. I understand that any
misrepresentation, falsification, or material omission of information on this application may
cause this application to be null and void and could result in the loss of SFA’s financial support
and opportunity to participate in the Seneca MSW@USC program. I understand that if selected
by Seneca’s review team to participate in this program, I must complete the University of
Southern California’s admissions process in order to be officially accepted into the program.
Applicant
Signature
Date:
6