SCHOOL OF COMPUTER & INFORMATION SCIENCES
APPLICATION FOR GRADUATE ADMISSION

All materials submitted in conjunction with an application become the property of Georgia Southwestern State University and will not be returned.

Admission requested for: (Please Check One)
Fall (August) Spring (Jan) Summer (June) Year 20

APPLICANT INFORMATION
Full Legal Name First (given) Middle Last
Permanent Mailing Address Street Address Apt No.
City State Zip
County Telephone (including Area Code) Email Address
Indicate other names used on official
records if different from above: 		First Middle Last
Contact in case of emergency Parent      Spouse      Guardian      Other
First Last Telephone (including Area Code)
Address Apt No.
City State Zip

Citizenship:
US Citizen Resident Alien (copy of green card required)
Non-Resident Alien
Country of Citizenship (if not US)
Visa Type
Residency Status:  Legal Resident of Georgia?
Yes  If yes, how long?   (Years) (Months)   County
No  If no, legal state of residency

DEMOGRAPHIC INFORMATION
Birthdate
Place of Birth (City, State)
Gender
Female
Male
Marital Status
Single
Married
Divorced
Widowed
Separated
Ethnic Origin: (For Statistical Purposes Only)
Black
Multi-racial
Asian or Pacific Islander
Hispanic
White (Non-Hispanic Origin)
American Indian/Alaskan Native

ACADEMIC INFORMATION
Classification:  Regular Admission
Master of Science in Computer Science
Computer Science
Computer Information Systems
Certificate Program (Online)
Computer Information Systems

Classification:  Non-Degree Admission
Personal Development
Post Baccalaureate
Transient

List all colleges and universities you have attended or are attending, including Georgia Southwestern State University. Official transcripts are required from each institution. If you are currently enrolled, give the last expected date of enrollment.
Name of Institution Attendance From (mm/yy) Attendance To (mm/yy) Degree Earned (mm/yy)
Date taken or scheduled (mm/dd/yy)
Scores (no more than 5 years old) will be submitted from:
(Not required for 2nd Master's Degree) 		GRE

Each applicant seeking regular admission must submit acceptable scores on the GRE. All test scores must be requested by the student and mailed from the testing agency directly to: Georgia Southwestern State University, 800 Wheatley St. Americus, GA 31709.

I certify that all statements made in this application are complete and true. I also understand that falsification of or failure to provide information requested may result in my immediate dismissal and/or loss of all credits from the University. If my application is accepted and I become a student, I agree to abide by the published regulations of the University and the policies of the Board of Regents of the University System of Georgia.
Yes, I agree No, I do not agree. Do not process my application Date: 
Signature ______________________________________________