TSU Distance Learning Application for Graduate Program or Concentration Change

IMPORTANT NOTICE!

If it has been less than one year since you submitted an application for admission and have ALREADY PAID the $40 application fee, but you now wish to admit into a different program and/or concentration, please complete and submit this form.

Term you wish to enter:
Academic Level:
Status:

Indicate "Transient" if you are a graduate student enrolled at another university other than Troy State, and select "Transient" in all other applicable areas for proposed major/course of study.
If Transient, list name of graduate school:
If you are a Transfer Student from another regionally accredited graduate school, list name of graduate school:

Applicant's First Name:		M.I.:
Applicant's Last Name:		Suffix:

Previous Last Name(s) Listed on Transcripts:
Social Security Number:		e-mail:

Primary Telephone:		Ext:
Secondary Telephone:		Ext:

Mailing Address:

Street Address:
Street Address:

City:

State:

Zip:

County:

Country:

Permanent Address (if different from above):

Street Address:
Street Address:

City:

State:

Zip:

County:

Country:

Date of Birth:

Gender:

Male Female

Marital Status:

Country of Citizenship:

Ethnic Origin*:
*Note: This information is voluntary and will not be used in any discriminatory manner.

Highest Degree Completed:		Date Completed:
Institution:

Proposed Masters:
Concentration:
Anticipated Date of Completion:
Financial Aid Intent:

Have you taken:

	GRE		MAT		GMAT
	TOEFL (International Students Only)		None Taken (GRE, GMAT or MAT required for admission)

Have you previously applied to the TSU system?	Yes No
If so, which Region/Campus?
If you previously applied, did you attend?	Yes No

List ALL educational institutions attended. Failure to report ALL institutions may result in dismissal.

Name of Institution	City & State	Type of Degree	Dates Attended MM/YYYY to MM/YYYY

TSU MUST receive all official transcripts for each institution of higher learning which you have attended.

Are you currently enrolled in the last institution attended?	Yes No
If yes, what will be your last date of attendance?	(MM/DD/YYYY)
Are you eligible for readmission to the college from which you are transferring?	Yes No
Note: A student on Temporary, Indefinite, Permanent or Academic suspension from another college or university is eligible to apply for admission to TSU after serving the suspension from the previous institution.
If no, are the reasons disciplinary or academic?	Disciplinary Academic
Have you been disciplined for an infraction of college or university standards?	Yes No If yes, explain in field below:
Note: Students on disciplinary suspension from another institution must be eligible to return to that institution before being considered for admission to TSU. Requests for waiver must be submitted in writing to the Dean of Graduate Studies and Research.

Are you a veteran?	Yes No
Have you ever been convicted of a Federal, State, County, or Municipality law?	Yes No If yes, explain in field below:

I hereby affirm that the information supplied in the blanks is complete and accurate. I understand that withholding information requested or giving false information may make me ineligible for admissions and enrollment.
Accept

There is no charge for submitting the Application for Graduate Program or Concentration Change. When you have completed all sections of this form, please click "Submit" to have your application for change of program or concentration electronically sent to the Distance Learning Graduate Admissions Department.