* Indicates Required Information

Enrollment Information

*Intended Start Term:
*Intended Start Year:
*Degree Status:
*Attendance Plan:
*Select a Program:
  All options without any specification are on main campus
GRE Testing Information
Date Taken/Scheduled:
GRE Verbal Score:
GRE Quantitative Score:
GRE Analytical Writing Score:
GRE Total Score:

Personal Information

*First: *Middle: *Last:
*City: *State: *Zip code:
*Day Phone

Evening Phone

*Gender *Birthdate
*Social Security Number:
First language if other than English:

In case of emergency, contact:

*First Name: *Last Name:

*City: *State: *Zip:

International Student

If you are NOT a U.S. Citizen, please complete this section.
Country of Citizenship:
Country of Birth:
Native Language (if other than English):
Do you currently reside in the U.S.?
Please select your classification:
If selected other or U.S. Visa Holder, please fill in:
TOEFL Score:

Educational Background

Please list ALL prior college/university attendance, including Ohio Dominican University.
An official transcript is required from each university attended, even if the credit is listed as transfer credit on another transcript.
All transcripts submitted become the property of Ohio Dominican University and are not returnable.
*Name of Institution:
*Start Date:     *End Date:    
*Major Course of Study:
*Degree Earned:
*GPA: based on a four point scale
Name of Institution:
Start Date:     End Date:    
Major Course of Study:
Degree Earned:
GPA: based on a four point scale
Name of Institution:
Start Date:     End Date:    
Major Course of Study:
Degree Earned:
GPA: based on a four point scale

Employment Background

Current Employer:
Current Position:
City: State: Zip:
Previous Employer:
Previous Position:
City: State: Zip:
If you are applying to the M.Ed Program, please fill this portion out:
Hold the ctrl key to select multiple
Teaching Certificate/License:
Subjects Instructed:

Professional & Volunteer Involvement

Start Date:     End Date:    
Position held:
Start Date:     End Date:    
Position held:

Background Information   (OPTIONAL)

Ohio Dominican University believes in equal opportunity and does not discriminate against any applicant on the basis of race, color, sex, ancestry, national origin, age, veteran status, sexual orientation, or religion, or against any otherwise qualified individual with disabilities in the administration of its admissions policies. The applicant is not required to answer these questions and refusal to answer will not affect admission. This information is collected and used for administrative and reporting purposes only.
Religious Preference:

Additional Information

*Have you ever been convicted of a crime other than a minor traffic violation?
If yes, please explain:  
*Please indicate how you first heard of Ohio Dominican's Graduate Programs:
*Will you be filing for financial aid through the Free Application for Federal Student Aid (FAFSA) form?
*Have you had any US Military experience?

Statement of Verification

I certify this information is true and complete to the best of my knowledge. Falsification of information on this application could jeopardize acceptance and enrollment. I authorize any institutions I have previously attended to release personal and academic information to Ohio Dominican University. Further, I grant that any college grades may be used for statistical studies or for evaluation purposes.
I certify that my name entered in the text field below counts for all intents and purposes for the submission of this form as my signature.