Graduate Education Application
This application must be completed for consideration of admission to any Graduate Education program.
Last Name *
First Name *
Preferred Name
Address *
Primary Phone *
Email *
NC Resident *
US Resident *
SSN (optional)
Gender (optional)
Race (optional)
Date of Birth *
MM
/
DD
/
YYYY
Emergency Contact Name and Phone Number *
Anticipated Semester to Begin *
Required
Anticipated Year *
Required
Program Applied for: Ballantyne Campus (all programs are face-to-face and/or hybrid)
Program Applied for: Online
Program Applied for: Special Cohorts (restricted to employees of the following school system)
Master of Arts in Teaching in Elementary K-6 (MAT)
Master of Arts in Education in Educational Leadership
Add-On Licensure in School Administration K-12
Union County Public Schools
Please list below all post-secondary institutions previously attended and state in which they are located. (You must submit one official transcript from each academic institution beyond high school via email to Dr. Charlesa Hann at c.hann@wingate.edu or mail it to 13024 Ballantyne Corporate Pl #150, Charlotte, NC 28277 Attn: Dr. Hann.) *
Please list all professional licenses or certificates with the expiration date of each. If you do not hold a license, please respond "none." *
Starting with the most current, please list the name, location, position held, and dates of service for each of your last three employers. *
How did you hear about our program? *
Comments and/or question
Below are the names of three references to whom recommendation forms should be sent. I understand that each reference will submit the completed form directly to the Graduate Education Office. I, hereby, waive any rights to see the completed recommendations. *
Required
Reference 1 Name and Email *
Reference 2 Name and Email *
Reference 3 Name and Email *
Upload CV or email it to Dr. Charlesa Hann at c.hann@wingate.edu
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