* Important -- required fields are marked with an asterisk and red in color. Items that are optional information are in black. While your permanent address is required, your current mailing address (optional), if different, may be helpful in speeding materials to you.
Personal Information
* Social Security Number
* Last Name
* First Name M. Initial
Maiden Name, if applicable:
* Date of Birth? (mm/dd/yy)
Are you a U.S. citizen or permanent resident of the United States? Yes No
If no, country of citizenship:
Bloomsburg University is required to collect and report information pertaining to the ethnic backgrounds of applicants. This information will not affect the admissions decision rendered on your application.
* Race or ethnicity
Select
African-American
American Indian
Alaskan Native
Asian
Pacific Islander
Hispanic
Caucasian
Present Address
Number and Street
City or Town State: Zip
County Code
Select
01-Adams
02-Allegheny
03-Armstrong
04-Beaver
05-Bedford
06-Berks
07-Blair
08-Bradford
09-Bucks
10-Butler
11-Cambria
12-Cameron
13-Carbon
14-Centre
15-Chester
16-Clarion
17-Clearfield
18-Clinton
19-Columbia
20-Crawford
21-Cumberland
22-Dauphin
23-Delaware
24-Elk
25-Erie
26-Fayette
27-Forest
28-Franklin
29-Fulton
30-Greene
31-Huntingdon
32-Indiana
33-Jefferson
34-Juniata
35-Lackawanna
36-Lancaster
37-Lawrence
38-Lebanon
39-Lehigh
40-Luzerne
41-Lycoming
42-McKean
43-Mercer
44-Mifflin
45-Monroe
46-Montgomery
47-Montour
48-Northampton
49-Northumberland
50-Perry
51-Philadelphia
52-Pike
53-Potter
54-Schuylkill
55-Snyder
56-Somerset
57-Sullivan
58-Susquehanna
59-Tioga
60-Union
61-Venango
62-Warren
63-Washington
64-Wayne
65-Westmoreland
66-Wyoming
67-York
98-Foreign
99-Out of State
Current telephone number Area Code:
Phone:
Present address effective until:
* E-mail Address:
Permanent Address
* Number and Street
* City or Town * State: * Zip
County Code
Select
01-Adams
02-Allegheny
03-Armstrong
04-Beaver
05-Bedford
06-Berks
07-Blair
08-Bradford
09-Bucks
10-Butler
11-Cambria
12-Cameron
13-Carbon
14-Centre
15-Chester
16-Clarion
17-Clearfield
18-Clinton
19-Columbia
20-Crawford
21-Cumberland
22-Dauphin
23-Delaware
24-Elk
25-Erie
26-Fayette
27-Forest
28-Franklin
29-Fulton
30-Greene
31-Huntingdon
32-Indiana
33-Jefferson
34-Juniata
35-Lackawanna
36-Lancaster
37-Lawrence
38-Lebanon
39-Lehigh
40-Luzerne
41-Lycoming
42-McKean
43-Mercer
44-Mifflin
45-Monroe
46-Montgomery
47-Montour
48-Northampton
49-Northumberland
50-Perry
51-Philadelphia
52-Pike
53-Potter
54-Schuylkill
55-Snyder
56-Somerset
57-Sullivan
58-Susquehanna
59-Tioga
60-Union
61-Venango
62-Warren
63-Washington
64-Wayne
65-Westmoreland
66-Wyoming
67-York
98-Foreign
99-Out of State
Telephone number * Area Code:
* Phone:
Daytime Phone No. Area Code:
Phone:
Your educational goals
Application for semester beginning Fall
Spring Summer Year: 20
I am applying for Full-time status Part-time status Readmission
What graduate degree program do you plan to enroll in at
Bloomsburg University: MA MEd MS MSN MBA MAC Adult, NP Cert
Non-degree
Are you applying for non-degree enrollment ONLY? : Yes (only if you do not intend to pursue a degree at Bloomsburg. Maximum of 12 credits.) No
Are you applying for Act 48 Non-degree enrollment? Yes (check only if you are pursuing a credits to fulfill Act 48 requirements only and do not intend to pursue a degree.) No
* Graduate curriculum (field of specialization) you plan to pursue:
Select
Athletic Training/Clinical (M.S.)
Audiology (Au.D.)
Business Administration (MBA)
Biology (M.Ed.)
Biology (M.S.)
Business Education (M.Ed.)
Business Education w/certification (M.Ed.)
Counseling (M.Ed) Student Personnel Svcs
Counseling (M.Ed) Elementary School
Counseling (M.Ed) Secondary School
Curriculm and Instruction (M.Ed.)
Curr & Instruction w/certification(M.Ed.)
Curr & Instruction superv. cert.
Early Childhood Education (M.S.)
Education of the Deaf/Hard of Hearing (M.S.)
Elementary Education (M.Ed.)
El. Education (M.Ed.) w/certification
English as 2nd Language certificate
Exceptionalities (M.S.)
Exceptionalities (M.S.) w/cert.
Exercise Science(M.S.) (Thesis)
Exercise Science(M.S.) (Non-Thesis)
Instruct. Technology (M.S.) (Corporate)
Instruct. Technology (M.S.) (Education)
Instruct. Technology (eLearning Certif)
Managerial Decision Making Certificate
Non-degree
Nursing (M.S.N.)
NP (Post MSN Cert. Program)
Principal Cert.
Radiologist Assistant (M.S.)
Reading (M.Ed.)
Spec. Education (M.S.)
Spec. Education Superv. Cert.
Speech-Language Pathology (M.S.)
Speech Pathology CEU credits
Your educational background
Undergraduate major:
Undergraduate minor, if any:
Have you ever taken graduate courses through Bloomsburg University? Yes No If so, when?
Do you presently hold teacher certification? Yes No
If you are enrolled in one of our off-campus sites, indicate location
How did you become aware of our graduate program:
Area
resident Peterson's Guide Grad School Guide BU undergraduate Faculty advisor Poster Newspaper Graduate Fair/Forum Other (please specify source)
Please Check one: I have requested Will request
that all official transcripts will be forwarded. If the transcript will appear under another name, please indicate name:
Please Check one:
I have taken I shall take (check all that apply) the...
GMAT
GRE
Miller Analogies Test
TOEFL
Date Test Taken:
I have have not requested scores to be sent.
Affidavit By
typing my name below I certify that any information contained on this application is correct.
* Name of applicant * Date
(mm/dd/yy)
When you are finished, click on the submit button to send your application to the School of Graduate Studies at Bloomsburg University of Pennsylvania.
Bloomsburg University of Pennsylvania is committed to providing equal education and employment opportunities for all persons without regard to race, color, religion, sex, age, national origin, ancestry, life style, sexual orientation, disabilities, Vietnam era veteran status or union membership. The university is also committed to affirmative action and will take positive steps to provide such educational and employment opportunities. Inquiries may be directed to the Director of Social Equity, Waller Administration Building, Bloomsburg University, 400 E. Second Street, Bloomsburg, PA 17815-1301. The phone number is 570-389-4528.