UNIVERSITY OF ILLINOIS SPRINGFIELD

Graduate
Admission Application
[Link]

UIS Engaged in Your Future

UNIVERSITY OF ILLINOIS SPRINGFIELD

THE UNIVERSITY
The University of Illinois serves the people of Illinois, the nation, and the world on three campuses: Springfield, Urbana-Champaign, and Chicago. The faculty maintains the Universitys tradition of excellence in teaching, research, and public service. The University of Illinois Springfield (UIS) began admitting freshmen to the Capital Scholars Honors Program in the fall of 2001 and to the general freshman class in Fall 2006. Prior to that time, UIS functioned as an upper division institution serving transfer and graduate students; these two populations are still the largest at UIS. Faculty are committed to individualized academic instruction within the 23 undergraduate, 21 masters and one doctoral U of I degree program(s), ranging from traditional disciplines to career-oriented concentrations in business administration, social work, and public affairs. Because of its location, UIS offers students firsthand access to state government and public service through special courses, projects, and internship opportunities. For additional information, write, call, email, or visit our website: Office of Admissions University of Illinois Springfield One University Plaza, MS UHB 1080 Springfield, Illinois 62703-5407 (217) 206-4UIS (4847) or Toll-free 1-888-977-4UIS (4847) [Link] admissions@[Link]

APPLICATION FEE
Applicants must submit a non-refundable $60 application fee (or $75 international application fee) to help defray processing costs. Exemptions for the application fee are granted to the following individuals: University of Illinois faculty and academic professionals, as well as retirees, Permanent staff employees of the University and other institutions and agencies under the University Civil Service System who have been assigned to established permanent and continuous staff positions and who are employed for at least 50 percent of full time, or Persons eligible under the Illinois Veterans Grant Program. Please supply proof of military service. A written letter requesting an application fee waiver may be submitted to the Director of Admissions for applicants who cannot meet the cost of the fee because of financial hardship. In general, evidence of financial hardship is a family income at or below the low standard family budget of the Bureau of Labor Statistics or the receipt of a testing waiver from the American College Testing Program of the College Entrance Examination Board, or FAFSA. A fee wavier request form can be found at [Link]/admissions/[Link]

Graduate Applicants
The University of Illinois Springfield seeks to enroll academically well-qualified graduate students who have pursued strong preparatory curricula while in college and demonstrated the ability to be successful in their pursuits, both academic and nonacademic. Each program has established admission requirements that comply with campus policy; these requirements may exceed the general minimum requirements for admission. Some graduate programs require scores from the Graduate Record Exam (GRE) or the Graduate Management Admission Test (GMAT). All admission decisions are made by the academic program at the graduate level. Applicants should apply at least 3 months before their term of entry to ensure processing time by the Office of Admissions and specified academic program. Some graduate programs may have earlier deadlines. Applicants should also consult their chosen program regarding applicable deadlines. Applications for graduate admission will be evaluated based on the following criteria: college academic coursework, standardized test scores & grade point average, statement of academic and career goals, and letters of recommendation.
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OVERVIEW OF ADMISSIONS
GRADUATE APPLICANTS A graduate applicant is a degree-seeking student who applies for admission and has Earned or plans to earn a Bachelors Degree from a regionally accredited postsecondary institution by their term of entry to UIS, OR Earned or plans to earn a Masters Degree from a regionally accredited postsecondary institution by their term of entry to UIS. NON-DEGREE APPLICANTS A non-degree applicant is a student who Desires to take classes at UIS and/or pursue a graduate certificate but does not wish to earn a degree. Non-degree is a guest status and is typically not eligible for financial assistance.

College academic coursework Students should pursue rigorous and challenging college preparatory curricula. Grade trends and the rigor of courses completed throughout college will be considered. Standardized test scores & grade point average The following credentials will be considered: UIS requires a minimum GPA of 2.50 on a 4.00 scale to be considered for full admission to any program (academic programs may require higher). Programs may grant conditional admission to persons with less than the required GPA with the additional requirement of completing eight semester hours of courses at UIS (exclusive of prerequisites) with a grade-point average of at least 3.00. If conditional admission is granted, the program will specify which courses must be completed. GRE or GMAT scores may be required by an academic program. Official test scores should be sent to the Office of Admissions and will be forwarded onto the chosen academic program with an applicants credentials. To have GRE or GMAT scores reported to UIS use school code 1787.

to submit TOEFL scores. Note that if your native language is not English, you will also be required to take an English proficiency test on campus the week before registration. Applicants to the Doctor of Public Administration must demonstrate English proficiency with a score of at least 575 (paper based), 232 (computer based), or 88 (Internet based).

In addition to all credentials listed above, international students will need to send additional documentation required for issuance of an I-20. International students who want to be considered for GA or GPSI positions are encouraged to apply for admission into a UIS graduate program at least nine months prior to the March 15th deadline.

PRIORITY APPLICATION DATE FOR GRADUATE ASSISTANTSHIP (GA) OR GRADUATE PUBLIC SERVICE INTERNSHIP (GPSI) APPLICANTS
Priority Application Date March 15 In order to be eligible for consideration, applicants must be admitted into a UIS graduate degree program. To facilitate file completion and admission, applicants are strongly encouraged to initiate the application process at least three months prior to the GA/GPSI deadline. Files completed after March 15 will be added to the pool of eligible applicants after the first round selection process is completed. For more information regarding GA/GPSI and graduate admission, please visit our website at: [Link] (select the Support Departments link).

Statement of Academic and Career Goals / Writing Sample Applicants may be required to provide written evidence of their ability to perform at a high academic level by submitting a goals statement or writing sample. Applicants should consult their chosen program for requirements. Letters of Recommendation Applicants may be required to provide letters of recommendation. Applicants should consult their chosen program for requirements.

Certificate Applicants
Students who hold a bachelor's degree may enroll for courses at UIS in graduate certificates and professional development sequences. Certificate and professional sequences at UIS typically require admission to that specific certificate and transcripts from all universities/colleges attended. During the application process, applicants will be admitted as a non-degree student to facilitate registration and will be re-coded once the chosen program has made a decision to admit. While under non-degree status all restrictions of that status apply. Please note that certificate students are typically not eligible for financial assistance. Please call the Office of Financial Assistance at (217) 206-6724 if you have questions.

International Applicants
International students must have completed the equivalent of a bachelors degree earned in the United States; bachelors degrees earned abroad may or may not meet this requirement. Applicants must also have met all entrance requirements specified by their chosen UIS degree program. TOEFL - Test of English as a Foreign Language Applicants whose native language is not English must submit official TOEFL scores. To have TOEFL scores reported to UIS use school code 1787. For applicants to a masters degree program, a score of at least 550 (paper based), 215 (computer based), or 79 (internet based) is required. If you hold a U.S. bachelors degree with a GPA of at least 2.50 on a 4.00 scale, you are not required
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Non-Degree Applicants
Students who hold a bachelors degree may enroll for courses at UIS as a non-degree seeking graduate student. Non-degree students may take up to 12 semester hours of coursework before being required to clarify student status.

Any hours completed may or may not count toward graduation requirements and students must inquire with and receive graduate program approval for any hours completed to be counted. Non-degree students who choose to become degree candidates must complete regular admissions procedures, including acceptance into their chosen degree program. Please note that non-degree students are typically not eligible for financial assistance. Please call the Office of Financial Assistance at (217) 206-6724 if you have questions.

ETHNIC AND RACIAL INDENTIFICATION

Your response to these items is voluntary and will not be used in making a decision on your admission. Please enter your ethnic and racial identification information to help the University meet its federal reporting obligations. Additional information about these regulations is available on the University of Illinois web site at [Link] (The federal government has asked us to separate race and ethnicity data. Ethnicity is defined as the classification of a population that shares common characteristics, such as, religion, traditions, culture, langauage and tribal or national orgin. Race is defined as a human population considered distinct based on physical characteristics.) First, identify whether or not your ethnicity is Hispanic or Latino, regardless of race. Second, select one or more races from the five racial groups. Ethnicity Identification (select one): Hispanic or Latino Not Hispanic or Latino Racial Identification (select as many as apply): American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Computer Science (MS) (on campus) Computer Science (MS) (online) Educational Leadership (MA) English (MA) Environmental Sciences General (MS) Environmental Studies (MA) Sustainable Development & Policy (on campus) Sustainable Development & Policy (online) Environmental Planning & Management Environmental Humanities History (MA) American History European & World History Public History Human Development Counseling (MA) Human Services (MA) Alcohol & Substance Abuse Child & Family Studies Gerontology Social Services Administration (on campus) Social Services Administration (online) Legal Studies (MA) Legal Studies (MA) (online) Liberal & Integrative Studies (MA) (on campus) Liberal & Integrative Studies (MA) (online) Management Information Systems (MS) Management Information Systems (MS) (online) Political Science (MA) Academic Politics Practical Politics Public Administration (MPA) (on campus) Public Administration (MPA) (online) Public Administration (DPA) Public Affairs Reporting (MA) Public Health (MPH) Environmental Health (MPH) (on campus) Environmental Health (MPH) (online) Teacher Leadership (MA) (online) Graduate Non-Degree

40PH0112MS 40PH0112MSU 40PG9725MA 40PH0311MA 40PF9912MS 40PF5161MA 40PF5161MAU 40PF5162MA 40PF9920MA 40PH0342MA 40PH5154MA 40PH5155MA 40PH5156MA 40PG1323MA 40PG9800MA 40PG9904MA 40PG9906MA 40PG9955MA 40PG9956MA 40PG9956MAU 40PF1410MA 40PF1410MAU 40PH5172MA 40PH5172MAU 40PE9890MS 40PE9890MSU 40PF0343MA 40PF5170MA 40PF5171MA 40PF0339MPA 40PF0339MPAU 40PF0339DPA 40PF1629MA 40PF9860MPH 40PF5044MPH 40PF5044MPHU 40PG4051MAU 40SB9949NDEG

Certificates Certificate Name

Alcohol and Substance Abuse Business Process Management (on campus) Business Process Management (online) Chief School Business Officer (online) Community Health Education Digital Organizations (on campus) Digital Organizations (online) Emergency Preparedness & Homeland Security (on campus) Emergency Preparedness & Homeland Security (online) English as a Second Language (Graduate Certificate) Environmental Health Environmental Risk Assessment (on campus) Environmental Risk Assessment (online) Epidemiology Graduate Professional Development Sequence in Gerontology Information Assurance (online) IT Project Management (on campus) IT Project Management (online)

Code
40PG3981CERT 40PE5159NDEG 40PE5159NDEU 40PG5038CASU 40PF5042CERT 40PE5158NDEG 40PE5158NDEU 40PF5036CERT 40PF5036CERU tba 40PG5044NDEG 40PF9947NDEG 40PF9947NDEU 40PF1239CERT 40PG3983NDEG 40PH4024NDEU 40PE5157NDEG 40PE5157NDEU

ACADEMIC PROGRAMS
Use this list to complete Intended Academic Program on page 2 of the application form. Failure to list the correct program name and code may result in incorrect program selection or inability to process your application. Intended Program Program Name
Accountancy (MA) Biology (MS) Business Administration (MBA) (on campus) Business Administration (MBA) (Peoria campus) Communication (MA)

Code
40PE0071MA 40PH0314MS 40PE9875MBA 40PE9875MBA5 40PH9953MA

Law for Human Services and Social Work 40PF4025NDEG Legal Aspects of Education (online) 40PG4088CERU Management of Non-Profit Organizations 40PF3984CERT Pathway to the Principalship for National Board Certified Teachers (on campus) 40PG5153CAS Pathway to the Principalship for National Board Certified Teachers (online) 40PG5153CASU Public Sector Labor Relations 40PF9945NDEG School Counselor 40PG3982NDEG School Administrative General Administrative 40PG9943NDEG Superintendent Certificate 40PG5037CAS Systems Security (online) 40PG4023NDEU Teacher Education (Certification Sequence) Elementary Education 40PG9940NDEG Secondary Education (on campus) 40PG9941NDEG Secondary Education (online) 40PG9941NDEU Women & Gender Studies 40PH5160NDEG

for the upcoming academic year by mid-December and should be filed as soon after January 1st as possible. Federal income tax returns filed by April of each year are required to complete the FAFSA form (eg. 2009 income taxes will be used to complete the 2010-2011 application). Tax returns must be completed in order to accurately fill out the FAFSA, but they do not have to actually be filed with the IRS. Therefore, it is recommended that students and/or their parents complete their tax returns as soon as possible and then immediately complete the FAFSA form transferring the necessary information from their taxes to the federal application. In order to be granted financial assistance, you must: Be fully admitted to your graduate program. Conditionally admitted graduate students may be eligible for aid, but you need to check with the Office of Financial Assistance to determine if you are eligible and to find out what limitations exist. Enroll in at least six hours each semester that lead to a degree. Make satisfactory academic progress measured by the completion rate, GPA, and maximum time frame (applies to returning students only). A copy of the Satisfactory Academic Progress Policy can be obtained from the Office of Financial Assistance or can be viewed at [Link]/financialaid. These standards are established by the U.S. Department of Education and may differ from the academic policies of the University. Respond to any request for information from OSFA. As a result of applying for federal assistance, students may be cited by the federal processor or state agency for additional documentation requirements. Critical Dates Affecting Financial Assistance Applicants for need-based assistance should be aware of the following dates (applicants should apply as soon as possible after January 1): December 1 UIS Institutional Scholarship Application available at [Link]/financialaid. February 15 Institutional Scholarship applications due. March 1 Application for fall semester assistance should be initiated to ensure consideration for all forms of aid. May 1 Applications should be complete (including results of needs analysis) to ensure consideration for all forms of assistance for fall semester. October 1 Application for spring semester assistance should be initiated to ensure consideration for all forms of aid. November 15 Application deadline for fall term. April 15 Application completion deadline for spring term. June 15 Application deadline for summer term.
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ENGLISH AS A SECOND LANGUAGE

The English as a Second Language (ESL) Department works with international and domestic students whose native language is not English. Students do not need to be enrolled at UIS to take advantage of these programs. Credit classes are offered year round. More information can be found at [Link] If you are interested in these programs or applying to one of these programs, please mark the appropriate place on page 2 of the application form.

FINANCIAL ASSISTANCE
The Office of Financial Assistance at UIS coordinates federal, state, institutional, and private financial aid programs for students. Assistance is available in the form of grants, tuition waivers, scholarships, student and parent loans, part-time employment, and veterans benefits. Applications for all forms of financial assistance may be obtained from the Office of Financial Assistance unless otherwise specified. Please contact the Office of Financial Assistance at 206-6724 or access their web site at [Link]/financialaid. Application Procedures for Financial Assistance To be awarded most types of state, federal, and institutional need-based financial assistance, students must complete the following steps: Complete the Free Application for Federal Student Aid (FAFSA) or the Federal Renewal Application, indicating UIS (school code 009333) as a school choice. The FAFSA may be accessed and submitted via the Internet at [Link]. The processor will send the results directly to UIS and, for Illinois residents, to the Illinois Student Assistance Commission, initiating an evaluation of eligibility for state grants. FAFSA forms are made available

AVERAGE COSTS FOR 2010-2011

As of June 1, 2010 (based upon 12 hours of enrollment each term) Illinois Residents Tuition Fees & Assessments Books, supplies, parking Total Non-Illinois Residents Tuition Fees & Assessments Books, supplies, parking Total

$6,774 $2,266.50 $1,260 $10,300.50

$15,078 $2,266.50 $1,260 $18,604.50

Note: These figures are subject to change by the University of Illinois Board of Trustees and are not the Financial Assistance Total Estimation of Cost.

UNIVERSITY HOUSING & RESIDENTIAL LIFE

Rates listed are per person/per semester and can be located at the following web address: [Link]/housing Housing charges include all costs for water, sewer, trash removal, electricity, cable TV, local telephone service, and high speed internet connectivity using the campus data network. Long distance calls must be made via calling card or cell phone. Each apartment includes a stove, frostfree refrigerator, microwave oven, draperies/ blinds, smoke detectors, and central air conditioning and heating. Furnishings included in apartment units (excluding unfurnished family apartments) are a sofa, living room chairs, dining room set, desks, beds, and dressers. A coin-operated laundry facility, exclusively for resident use, is located in each complex. Convenient parking is located near each complex. Residents are required to purchase and display a UIS parking hangtag. Single Student Housing Single graduate students are housed in furnished apartments. Room/rental costs vary according to the type, size and level of privacy in each accommodation. The wide variety of living options and range of housing costs allow students to obtain the accommodations that best meet their personal and financial requirements. Apartment Housing: 4 bedroom flat / 4 person / private bedroom 2-3-5 bedroom renovated flat / 2-5 person / private or shared bedroom 4 bedroom townhouse / 4 person / private bedroom 2 bedroom flat / 4 person / shared bedroom
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Family Housing Students who will be residing with their legal spouse and/or legally dependent children under 18 are eligible to apply for a limited number of family housing units. Official copies of your marriage certificate and birth certificate/proof of guardianship must also be sent if your spouse/children will be occupying your apartment. Note that because of the size of the units, no more than two adults and one child may occupy one-bedroom units; no more than two adults and two children or one adult and three children may occupy two-bedroom units. UIS is located in the Ball-Chatham School District. Ball-Chatham Schools have long had an excellent reputation for its fine schools, teachers, administrators and support staff. Current year academic scores at grades three through eight are outstanding, and rank with the best schools in the state. Glenwood High Schools composite ACT score is one of the best in downstate Illinois. School bus routes run through the UIS campus. UIS operates a child care center primarily for students with infants and children up to 13 years of age (after school and summer camp program for older children). For additional information, contact the Cox Center at 206-6610, Monday through Friday, 7:30 A.M. to 5:30 P.M. Family Housing: One-Bedroom Furnished Two-Bedroom Furnished One-Bedroom Unfurnished Two-Bedroom Unfurnished Dimensions There are several variations in floor plans among the various apartment units, with approximate dimensions listed below. Please check our website for more specific information. One Bedroom Living Room 12 x 18 Kitchen 86 x 7 Bedroom 146 x 10 Dining Room Bath 9 x 8 86 x 5

Two Bedroom Living Room 14 x 126 Kitchen 86 x 7 Bedroom 1 13 x 96 Dining Room Bath Bedroom 2 10 x 8 8 x 5 146 x 10

Four Bedroom Living Room 14 x 156 Kitchen 10 x 76 Bedroom(s) 11 x 10 Dining Room Bath 11 x 9 8 x 5

Dining Plan Request Apartment residents may or may not purchase a meal plan according to preference. Meal Plan information can be obtained from the I.D. Center at (217) 206-7718 or by visiting [Link]/foodservice/mealplans.

Housing Application Process and Requirements Housing applications are available at [Link] The housing application, along with a housing deposit (payable to UIS Housing), must be returned to the Housing Office. Housing deposits are $200 for single student housing and $300 for family housing. Room assignments are made based on the date that the completed application and deposit are received. Where possible, indicated roommate preferences will be accommodated. Graduate students are encouraged to live on campus, but are not required to.

CRIMINAL DISCLOSURE
The University of Illinois Springfield is committed to maintaining a safe environment for all members of the University community. As part of this commitment, the University requires applicants who have pending criminal charges or have been convicted of a felony crime to disclose this information as a mandatory step in the application process. In addition, if you have ever been expelled or dismissed from an educational institution for disciplinary reasons, an accurate and complete explanation of the circumstances and your current status is required as part of the admission process. A previous conviction, pending criminal charges, or other expulsion or dismissal does not automatically bar admission to the University, but does require review and evaluation.

HEALTH SERVICES
Immunization Requirement: Students born January 1, 1957, or after, are required by Illinois law to provide proof of immunization against measles, mumps, rubella, diphtheria and tetanus. All immunization documents must be verified and signed by a physician licensed to practice medicine in all of its branches (M.D. or D.O.); local health authority, school, college or university health service, registered nurse, or an Illinois Department of Public Health recognized vaccine provider. Students who are not citizens of the United States are required to have a tuberculin skin test administered either at UIS or at an Illinois Department of Public Health recognized vaccine provider (e.g.: Public Health Department, or another Illinois university health service). The test must be administered and read before students will be allowed to attend class at UIS. Non-citizens who have been treated or undergone a tuberculosis program should bring medical records with them. Records without a certified English translation will not be accepted. (If the TB test is positive, a chest x-ray will be required prior to attendance at UIS.)

AN INVITATION TO VISIT OUR CAMPUS

The Office of Admissions welcomes prospective students to campus Monday through Friday (except holidays). Appointments to meet admissions counselors, faculty, financial aid representatives, and to schedule campus and housing tours may be made by calling the office at (217) 206-4UIS (4847) or toll-free 1-888-977-4UIS (4847).

IMPORTANT CONTACTS
OFFICE OF ADMISSIONS University of Illinois Springfield University Hall One University Plaza, MS UHB 1080 Springfield, IL 62703-5407 Toll-free 1-888-977-4UIS (4847) (217) 206-4UIS (4847) [Link]/admissions Email: admissions@[Link] Appointments with admissions counselors Campus tours Application materials

Arrangements can be made to receive the necessary immunizations on campus by contacting the Health Services Office. Students may request an exemption based on religious grounds by providing documentation to that effect. Medical exemptions require documentation by a physician describing what the contraindication is and the date the exemption is expected to end. Immunization forms must be complete and on file in Campus Health Service before 5:00 p.m. on the 10th day of the semester to avoid a non-refundable processing fee of $25. Students not in compliance by registration for their second semester at UIS will not be allowed to register until the required immunization information has been completed and submitted. Questions concerning this policy should be directed to the Campus Health Service, (217) 206-6676, [Link]/healthservices.
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OFFICE OF FINANCIAL ASSISTANCE University of Illinois Springfield University Hall One University Plaza, MS UHB 1042 Springfield, IL 62703-5407 Toll-free 1-888-977-4UIS (4847) (217) 206-6724 [Link]/financialaid Financial assistance and scholarships

HOUSING OFFICE University of Illinois Springfield Housing Commons One University Plaza, MS HBC 1 Springfield, IL 62703-5407 (217) 206-6190 [Link]/housing Housing applications continued on back

STUDENT ORIENTATION University of Illinois Springfield Student Affairs Building One University Plaza, MS SAB 20 Springfield, IL 62703-5407 (217) 206-6662 [Link]/studentaffairs/orientation email: studentorientation@[Link]

CRIMINAL DISCLOSURE REVIEW COMMITTEE c/o Associate Dean of Students University of Illinois Springfield One University Plaza, MS SAB 23 Springfield, IL 62703-5407

The commitment of the University to the most fundamental principles of academic freedom, equality of opportunity, and human dignity requires that decisions involving students and employees be based on individual merit and be free from invidious discrimination in all its forms, whether or not specifically prohibited by law. The policy of the University of Illinois is to comply with all federal and state nondiscrimination, equal opportunity, and affirmative action laws, orders, and regulations. The University of Illinois will not discriminate against any person because of race, color, religion, sex, national origin, ancestry, age, marital status, handicap, unfavorable discharge from the military, or status as a disabled veteran or veteran of the Vietnam era. This nondiscrimination policy applies to admission, employment, and access to and treatment in University programs and activities. Among the forms of invidious discrimination prohibited by University policy and law is sexual orientation. Complaints of invidious discrimination based solely upon policy are to be resolved within existing University procedures.

For additional information on the equal opportunity and affirmative action policies of the University, please contact the Associate Chancellor for Access and Equal Opportunity: Office of Access and Equal Opportunity University of Illinois Springfield One University Plaza, MS PAC 563 Springfield, IL 62703-5407 (217) 206-6222 [Link]/aeo This publication was produced by the Office of Campus Services in collaboration with the Office of Admissions. The University of Illinois is an equal opportunity, affirmative action institution.

[Link]/admissions

Printed by Authority of the State of Illinois 6.10-4,500-47511

UNIVERSITY OF ILLINOIS SPRINGFIELD

Office of Admissions University Hall One University Plaza, MS UHB 1080 Springfield, IL 62703-5407 Admissions (217) 206-4847 Financial Assistance (217) 206-6724 Records (217) 206-6709 Registration (217) 206-6174 Toll Free (888) 977-4847

Application for Graduate Admission Section 1

NAME First name Last name Previous name, if applicable First Middle Year For which previous term? r Spring r Fall r Summer Year Last Middle name I am applying as a (see page 2 for definitions): r Graduate r Certificate (note restrictions, see page 3) r Non-Degree (note restrictions, see page 3) Office use only: r GA r GPSI

For which term do you wish to apply? r Spring r Fall r Summer

Have you ever previously applied to the University of Illinois Springfield? r Yes r No Have you ever applied to another University of Illinois Campus? r Yes r No CURRENT MAILING ADDRESS Street Address / Rural Route / P.O. Box City Country Mailing Address Phone ( State )

If yes, please list your University Identification Number (UIN)

Apt. Zip Code + extension Cell Phone ( ) County Work Phone ( )

EMAIL ADDRESS (Required for International Students) Preferred email address for all ocial UIS communications. PERMANENT HOME ADDRESS (Give only if different from current mailing address.) Street Address / Rural Route / P.O. Box City Country GENERAL INFORMATION r Male r Female Date of Birth Social Security Number* State Permanent Home Phone ( ) Zip Code + extension Apt. County

* We are requesting your Social Security Number pursuant to Public Law 93-579 for the Universitys system of student records as well as for compliance with federal and state reporting requirements. A Social Security Number is required if you are applying for financial aid but is not required for admission to the University. Providing a Social Security Number will, however, speed up the processing of your application since we will not need to manually match your application with other materials such as transcripts and test scores. Supplying an SSN ensures that you will be able to claim the Hope Tax Credit if you are eligible on your federal tax return. The University has a strong commitment to ensuring the privacy and confidentiality of student records and will not disclose your Social Security Number without your consent for any purpose as allowed by the law.

Place of Birth* City *If born outside of the U.S., please provide proof of U.S. Citizenship++ r I am a U.S. Citizen. Are you an Illinois Resident? r Yes r No

State

Nation (if not U.S.)

Length of time in Illinois: Year(s)

Month(s)

r I am a Permanent Resident. Enclose a copy of your alien registration card.++ Non-U.S. Citizens indicate country of citizenship

r I have other Immigrant Status. Enclose a copy of your documentation of other status.++ ++Documentation of your status must be submitted with this application. Application will not be processed without documentation.

Racial and Ethnic Identification (answering this question is voluntary and will not be used in making a decision on your admission see page 4) Racial Identification (select as many as apply): r American Indian or Alaska Native r Native Hawaiian or other Pacific Islander Are you a veteran of U.S. military service? r Yes r No r Asian r White r Black or African American r Other Ethnic Identification (select one): r Hispanic or Latino r Not Hispanic of Latino

If yes, you may wish to submit a photocopy of your DD214 for a possible 4 hours of credit.

IN AN EMERGENCY CONTACT r Mother r Father r Spouse r Other First name Home Phone ( ) Cell Phone ( ) Last name Work Phone ( ) Apt. State Zip Code + extension Country

Street Address / Rural Route / P.O. Box City EDUCATIONAL GOALS I wish to pursue a: r Masters Degree r Second Masters Degree r Doctoral Degree r Certificate r I am a Non-Degree Seeking Student

Non-Degree Seeking Students: r Yes I have read and understand that I do not wish to pursue a degree, but want to take courses as a non-degree seeking student. I may take up to 12 semester hours as a graduate student before I will be required to clarify my student status. Any hours completed may or may not count toward graduation requirements and students must inquire with and receive graduate program approval for any hours completed to be counted. (Please complete the colleges/universities attended and courses in progress sections.) Please note that non-degree students are typically not eligible for financial assistance. Please call the Office of Financial Assistance at (217) 206-6724 if you have questions. r I am applying for the Summer Intensive English Language Program. r I am interested in the ESL courses to improve my English Language skills. INTENDED ACADEMIC PROGRAM Please see Page 4 for lists and codes. Program Name Certificate Code Code

I plan to earn the Illinois State Board of Education Teaching Certificate in: r Elementary Education r Secondary Education EDUCATIONAL HISTORY It is very important that you provide complete information. There is additional space on back of application if needed. COLLEGES AND UNIVERSITIES ATTENDED All applicants must list all colleges and universities attended. Include the University of Illinois Springfield. Give country if not in the U.S. Prior College 1 Name City r Not in the U.S. Prior College 2 Name City r Not in the U.S. Prior College 3 Name City r Not in the U.S. Prior College 4 Name City r Not in the U.S. Prior College 5 Name City r Not in the U.S. Country State Country Degree From Date To Date State Country Degree From Date To Date State Country Degree From Date To Date State Country Degree From Date To Date State Degree From Date To Date

If you have earned graduate credit and are applying for a masters degree, please indicate the total hours completed toward a masters degree by time of entry to UIS:

College courses for all terms in progress or planned before desired date of entry. List the courses you are currently taking and any other you anticipate taking prior to the desired date of entry to the University of Illinois Springfield. Include summer school. If none, state NONE. The information will be used to compute the total semester hours you will have earned by your desired term of entry. It is very important that you provide complete and accurate information. If you need additional room, see back side or include a separate page. Term & year you will complete course (e.g. Fall 2010) Course dept. & course # as listed in catalog Dept. Prefix & No.

Institution

Course title as listed in catalog

Sem. Hrs.

Qtr. Hrs.

CRIMINAL DISCLOSURE This section must be completed and submitted by all applicants The University of Illinois Springfield is committed to maintaining a safe environment for all members of the University community. As part of this commitment, the University requires applicants who have pending criminal charges or have been convicted of a felony crime to disclose this information as a mandatory step in the application process. In addition, if you have ever been expelled or dismissed from an educational institution for disciplinary reasons, an accurate and complete explanation of the circumstances and your current status is required as part of the admission process. A previous conviction, pending criminal charges, or other expulsion or dismissal does not automatically bar admission to the University, but does require review and evaluation. All applicants must answer both of the following questions: 1. Do you have criminal charges pending against you or have you been convicted of a felony crime? r Yes r No 2. Have you been expelled or dismissed from an educational institution for disciplinary reasons? r Yes r No If you answered Yes to either of these questions, you must submit the following information: a brief, accurate explanation, location of conviction (city, state, country) pending criminal charge(s), suspension(s), or expulsion, date and court disposition, in English. This statement must also include a grant of irrevocable authorization to the University for complete access to criminal records, if any. Applicants are responsible for verifying receipt by the University. Complete information must be sent at the time of application for admission to: Review Committee, c/o Associate Dean of Students, University of Illinois Springfield, One University Plaza, MS SAB 23, Springfield, IL 62703-5407 IMPORTANT FOR ALL APPLICANTS All students pursuing a degree or certificate must provide the Office of Admissions with all official transcripts sent directly from your school(s), including the school you are currently attending. You will then need to submit the final transcript upon completion of your last term there. Non-degree seeking students will be required to submit official transcripts prior to pursuing a degree or certificate. DISCLOSURE STATEMENT I understand that withholding pertinent information requested on this application or giving false information will make me ineligible for admission to the University or subject to cancellation of registration if admission has been granted. I certify that the statements on this application are correct and complete, including a report of all possible collegiate credit as described in the application for admission instructions. I give my permission to officials at all the institutions I have attended to release information needed by the University of Illinois Springfield to substantiate statements I have made on this application. I have or will have received a United States bachelors degree or its accepted equivalent by the term of entry.

SIGNATURE

DATE

Is your application complete?

Be sure that: r All official transcripts have been requested to be sent to UIS (address on front page). r Application is signed. r Test scores have been requested to be sent to UIS. r $60 Application Fee (or waiver request) is enclosed ($75 for international applicants).

ADDITIONAL SPACE IF NEEDED

Printed by Authority of the State of Illinois 6.10-4,500-47511

GRADUATE ASSISTANTSHIP (GA) AND/OR GRADUATE PUBLIC SERVICE INTERNSHIP (GPSI) APPLICATION INSTRUCTIONS
University of Illinois Springfields Graduate Assistantship (GA) and Graduate Public Service Internship (GPSI) programs are designed to provide funding to aid in defraying educational costs for assistants/interns, to provide high quality graduatelevel learning experiences for Masters degree candidates and to assist academic programs, public affairs research centers, and other campus units in fulfilling their missions. GA and GPSI candidates are selected through a competitive process based upon applicants qualifications and fit with departmental or agency needs. To be appointed to a GA or GPSI position, students must be admitted to graduate study or must already be enrolled and in good standing in a graduate program at the university with no incomplete grades. 5. third may be completed by another faculty member or by an employer and must be dated within the past 1.5 years. (These forms are included in this booklet.) If you are applying to both the GA & GPSI programs, only one letter from each reference is required. Copies will be provided to both offices. The personal goal statement must be specific to the GA/ GPSI programs and written using your own words based on your own life experiences. The statement must be submitted on our form and should be typed, single-spaced and no more than two pages in length. The questions should be left in the body of the form as they appear. The form can be found on either the GA or the GPSI website: [Link] apply/[Link] or [Link] click on Prospective Interns, click on Applicant Info & Forms. If you have been assigned a University Id Number (UIN) please include your UIN number on the personal goal statement form. NOTE: This form is interchangeable between the GA and GPSI programs. There is no need to complete one form for a GA position and one form for a GPSI position. 6. International applicants are welcome to apply to the GA and GPSI programs; however, F-1 visa status is required to be eligible for both programs. Proof of F-1 visa status must be on file with the GPSI office before any GPSI interviews are scheduled. Proof of F-1 visa status must be on file with the GA office before an assistant is allowed to begin working. Please note that if you are currently completing an UNDERGRADUATE degree and are applying to the GA/GPSI programs, your undergraduate degree must be officially posted and the final transcript submitted to the UIS Office of Admissions before you are eligible to begin working in either your assistantship or internship position. If you are currently completing a UIS GRADUATE degree and are applying to the GA/GPSI programs, please contact the GA and/or GPSI programs to determine application eligibility.

(Only complete and return if applying for GA/GPSI.)

Because being both a graduate student and a GA or GPSI will occupy most of your time, we do not recommend that you hold an outside job during your assistantship/internship. Nevertheless, we do not prohibit you from holding off-campus employment; however, in no event may this additional job exceed 20 hours per week. For the academic year beginning in August, an applicants file must be complete by March 15 to be eligible for first round consideration. A complete file consists of a GA/GPSI application, resum, personal goal statement, three letters of reference, transcripts, and admission for graduate study, including payment of the required graduate admission application fee. To facilitate file completion, applicants are strongly encouraged to initiate the application process at least three months prior to the application deadline. Files completed after March 15 will be added to the pool of eligible applicants after the first round selection process is completed. Applicants should contact the GA and GPSI offices to be informed of any new deadlines for subsequent rounds. This portion (Section II) of the UIS Application for Graduate Admission form can be used to apply for either the GA and/or the GPSI programs. This application is also available online. To have your application considered for a GA and/or GPSI position you must: 1. Complete Section I and Section II of the UIS Application for Graduate Admission. Submit the application forms and forward transcripts from all colleges and universities attended to: Office of Admissions University of Illinois Springfield University Hall, Room 1080 One University Plaza, MS UHB 1080 Springfield, IL 62703-5407 Apply for admission to an academic program by completing a program application form (if applicable) and meeting program application requirements. Email a resum and personal goal statement to both the GA and GPSI programs if you are applying to both. gaprog@[Link] gpsimail@[Link] Distribute the Letter of Reference forms to faculty and/or employers. Note: Two must be completed by a faculty member familiar with your academic work; the

DO NOT DETACH OFFICE USE ONLY

7.

FOR ADDITIONAL INFORMATION GRADUATE ASSISTANTSHIP Graduate Assistantship Office, PAC 518 University of Illinois Springfield One University Plaza, MS PAC 525 Springfield, IL 62703-5407 (217) 206-6544 gaprog@[Link] GRADUATE PUBLIC SERVICE INTERNSHIP GPSI Program, BRK 475 University of Illinois Springfield One University Plaza, MS BRK 475 Springfield, IL 62703-5407 (217) 206-6158 gpsimail@[Link]

2.

3.

4.

Section 2 Application for Graduate Assistantship and/or Graduate Public Service Internship
To be completed by students interested in applying for Graduate Assistantship and/or Graduate Public Service Internship.
NAME
(Please Print) Last / Surname First Middle

CURRENT MAILING ADDRESS:

Number and Street or R.R. or PO Box Apt. No.

City/Town

State

Zip Code + extension

Country

Home Phone (

Cell Phone (

) r Yes

E-mail r No

Have you ever previously applied to a University of Illinois campus? If yes, please list your University Identification Number (UIN): Which Campus? Intended Masters Program r Urbana r Chicago r Springfield

NOTE: If you change your intended Masters program, you will need to complete the Request for Change of Curriculum form with the UIS Office of Records and Registration and notify the GA and GPSI offices of the change.

I am interested in being considered for the following (check either or both): r Graduate Assistantship (GA) r Graduate Public Service Internship (GPSI) 0 = None 1 = Some 2 = Proficient
_____ Public Relations _____ Recycling/Waste Mgt _____ Student Housing _____ Student Organizations _____ Survey Research _____ Teaching _____ Training Development _____ Web Design

Please evaluate your experience, knowledge or skills in each of the areas below:
_____ Audio/Visual _____ Accounting _____ Advising/Counseling _____ Agriculture Skills _____ Archiving _____ Auditing _____ Broadcasting _____ Budgeting _____ Case Management _____ Child Welfare _____ City Management _____ Computer Use _____ Computer Programming _____ Customer Service _____ Data Analysis _____ Economic Analysis _____ Editing _____ Finance/Revenue _____ Fundraising _____ Graphics _____ Historical Research _____ Laboratory Research _____ Labor Relations _____ Law Enforcement _____ Legal Research/Writing

_____ Library Research _____ Lobbying _____ Management _____ Negotiation Skills _____ Human Resources _____ Photography _____ Policy Analysis _____ Public Health Screening

Please include a resum that provides information about your academic honors and work experience. In addition, you must submit a personal goal statement on the required form listed under item 5 in the Section II instructions on the previous page. Your responses must be written using your own words, based on your own experiences. UIS strongly urges all assistantship/internship applicants who are U.S. citizens or eligible permanent residents to complete the Free Application for Federal Student Aid (FAFSA). Have you completed the FAFSA for the upcoming academic year? r Yes r No, but I plan to r No, I will not be completing the FAFSA

DISCLOSURE STATEMENT

I understand that withholding information requested on this application or giving false information may make me ineligible for a position. I certify that the above statements are, to the best of my knowledge, complete and correct. I understand that before my candidacy can be considered the following conditions must be met: a.) I must be accepted by the graduate program to which I am applying. b.) I must submit an official undergraduate transcript and any graduate transcripts to the UIS Office of Admissions. c.) I must submit three current (within 1.5 years of application date) references. I understand that this application and any materials received in support of my application for a GA or a GPSI postition, including letters of reference, will be made available to and reviewed by representatives who have been selected to serve as search committee members for committees seeking to fill assistantship/internship vacancies. *Signature I was informed of the GA/GPSI programs through
The commitment of the University of Illinois to the most fundamental principles of academic freedom, equality of opportunity, and human dignity requires that decisions involving students and employees be based on individual merit and be free from invidious discrimination in all its forms. It is the policy of the University of Illinois not to engage in discrimination or harassment against any person because of race, color religion, sex, national origin, ancestry, age, marital status, disability, sexual orientation, unfavorable discharge from the military, or status as a disabled veteran or a veteran of the Vietnam era and to comply with all federal and state nondiscrimination, equal opportunity and affirmative action laws, orders and regulations. This nondiscrimination policy applies to admissions, employment, access to and treatment in programs and activities. Complaints of invidious discrimination prohibited by university policy are to be resolved within existing university procedures.

Date

*If you decide to withdraw from GA/GPSI consideration, please contact each program by email. Thank you.

Please attach to reference letter. Letter should be typed on university or business letterhead.

U N I V E R S I T Y

O F

I L L I N O I S

S P R I N G F I E L D

O F F I C E O F G R A D UAT E I N T E R N P RO G R A M S LETTER OF REFERENCE RELEASE

FORM

INSTRUCTIONS: Applicant completes form, including signature and date. Cut and distribute forms to the three letter writers for submission. We ask for two references from faculty members who are familiar with your education and abilities. The third letter can be from an employer or an additional faculty member. The letter writer must attach the release form to the letter, which must be typed on university or business letterhead. 1. Name of applicant: Last/Surname Proposed program of study: 2. Letter to be sent to: University of Illinois Springfield Street address: One University Plaza, MS BRK 475 City and state: Springfield, IL 3. 4. 5. In support of application for (check either or both): Zip code: 62703-5407 First Field of specialization (optional): Department: Office of Graduate Intern Programs Middle

Graduate Assistantship

Graduate Public Service Internship

t t

Please check box if you would like us to forward a copy of your reference letter to the academic program. I hereby waive whatever rights of access I may have to this confidential recommendation as provided in the Family Educational Rights and Privacy Act. Date:

Signature:

(Only complete and return if applying for GA/GPSI.)

Please attach to reference letter. Letter should be typed on university or business letterhead.

U N I V E R S I T Y

O F

I L L I N O I S

S P R I N G F I E L D

O F F I C E O F G R A D UAT E I N T E R N P RO G R A M S LETTER OF REFERENCE RELEASE

FORM

INSTRUCTIONS: Applicant completes form, including signature and date. Cut and distribute forms to the three letter writers for submission. We ask for two references from faculty members who are familiar with your education and abilities. The third letter can be from an employer or an additional faculty member. The letter writer must attach the release form to the letter, which must be typed on university or business letterhead. 1. Name of applicant: Last/Surname Proposed program of study: 2. Letter to be sent to: University of Illinois Springfield Street address: One University Plaza, MS BRK 475 City and state: Springfield, IL 3. 4. 5. In support of application for (check either or both): Zip code: 62703-5407 First Field of specialization (optional): Department: Office of Graduate Intern Programs Middle

Graduate Assistantship

Graduate Public Service Internship

t t

Please check box if you would like us to forward a copy of your reference letter to the academic program. I hereby waive whatever rights of access I may have to this confidential recommendation as provided in the Family Educational Rights and Privacy Act. Date:

Signature:

Please attach to reference letter. Letter should be typed on university or business letterhead.

U N I V E R S I T Y

O F

I L L I N O I S

S P R I N G F I E L D

O F F I C E O F G R A D UAT E I N T E R N P RO G R A M S LETTER OF REFERENCE RELEASE

FORM

INSTRUCTIONS: Applicant completes form, including signature and date. Cut and distribute forms to the three letter writers for submission. We ask for two references from faculty members who are familiar with your education and abilities. The third letter can be from an employer or an additional faculty member. The letter writer must attach the release form to the letter, which must be typed on university or business letterhead. 1. Name of applicant: Last/Surname Proposed program of study: 2. Letter to be sent to: University of Illinois Springfield Street address: One University Plaza, MS BRK 475 City and state: Springfield, IL 3. 4. 5. In support of application for (check either or both): Zip code: 62703-5407 First Field of specialization (optional): Department: Office of Graduate Intern Programs Middle

Graduate Assistantship

Graduate Public Service Internship

t t

Please check box if you would like us to forward a copy of your reference letter to the academic program. I hereby waive whatever rights of access I may have to this confidential recommendation as provided in the Family Educational Rights and Privacy Act. Date:

Signature: