Old Application for Graduate Admission

Application for Graduate Admission to the Department of Physiology and Health Science Ball State University, Muncie IN

Items with an * indicate a required field.

PERSONAL INFORMATION
First Name *
Middle Name
Last Name *
Address Line 1 *
City *
State *
Zip *
Country *
Phone
E-mail address
In which major are you interested?
In which degree are you interested?
When do you plan to start your graduate program? *
Do you plan to be a part-time (fewer than 9 credit hours/semester) or full-time (9 or more credit hours/semester) student? *
Goal Statement
Please write a 150 - 200 word statement explaining your goals.


EDUCATIONAL BACKGROUND
Institution 1 Name and Location
Dates Attended
Major(s)
Minor(s)
Degree Earned
Institution 2 Name and Location
Dates Attended
Major(s)
Minor(s)
Degree Earned
Institution 3 Name and Location
Dates Attended
Major(s)
Minor(s)
Degree Earned
What is(was) your overall undergraduate grade-point average based upon a four-point (A=4, B=3, C=2, etc.) system?
What is(was) your overall grade point average for your senior year?
Have you taken the Graduate Record Exam?	Yes No
If yes, when did you take it
and what were your scores?
(The GRE is helpful but not required by the department for M.A./M.S.)
Have you taken TOEFL (Test of English as a Foreign Language)?	Yes No
If yes, when did you take it
and what were your scores?

ACADEMIC RECORD
How did you hear about the Department of Physiology and Health Science at Ball State University?


GRADUATE ASSISTANTSHIP INFORMATION (If you wish to be considered for a graduate assistantship, please complete the appropriate sections below.)

If applying for an assistantship in HEALTH SCIENCE, please rank (1-4 with 1=highest priority) the top four of the following opportunities that you would be interested in.
Teach CPR and first aid skills (Note: you must be certified as an American Red Cross instructor at the start of fall classes)
Assist professor in Epidemiology/Statistics course (lecture and lab)
Assist professor in Health Commuication couse (lecture and lab)
Assist professor in large section Personal Health course
Assist professor in Elementary School Health course
Assist faculty in their research

If applying for an assistantship in ANATOMY/PHYSIOLOGY, in which of the following experiences would you be interested?
(check all that apply)	Assist faculty in the instruction of Physiology labs Assist faculty in the instruction of Anatomy labs Assist faculty in their research

COMPUTER SKILLS Some assistantship assignments utilize basic computer skills. Please describe any computer skills you have and programs with which you are familiar.
WORD PROCESSING
Mac or PC?
Applications (Word, Wordperfect, etc.)
STATISTICAL PACKAGE
Mac or PC?
Applications (Minitab, SPSS, etc.)
DESKTOP PUBLISHING
Mac or PC?
Applications (Pagemaker, Quark Express, Etc.)
PRESENTATION SOFTWARE
Mac or PC?
Applications (PowerPoint, etc.)

EMPLOYMENT AND PERSONAL EXPERIENCES Give a brief account of your present and past work and related experience. Start with your most recent experience. Include miliatry service, if applicable.
Employer 1 Name and Location
Start Date
End Date
Position Description

Employer 2 Name and Location
Start Date
End Date
Position Description

Employer 3 Name and Location
Start Date
End Date
Position Description


REFERENCES Please list the names of persons you have asked to write letters of recommendation on your behalf (two for professional references, one for a personal reference).

Please have these individuals send the letters to the Chairperson, Dept. of Physiology and Health Science, Ball State University, Muncie, IN 47306.
Professional Reference 1

Professional Reference 2

Personal Reference