Florida Memorial University
School of Education
Application for Master of Science in Reading Degree
Title
Name (first & last):
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Address:
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City, State:
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Zip Code:
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Day Phone:
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Evening Phone:
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E-mail:
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Country of Birth:
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Country of Citizenship:
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If you are not a U.S. citizen, select appropriate type of visa:
Native Language:
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Which basic skills test did you pass?
Date basic skills test was passed:
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Have you taken the Graduate Record Exam (GRE)?
Have you taken the TOEFL (if applicable)?
Have you ever attended Florida Memorial University (FMU)?
Graduation date from FMU:
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Under what name did you attend FMU?
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What was your major at FMU?
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Do you hold any of the following teaching certificates? (if yes, please submit a copy of the certificate).
Required
Are you ESOL endorsed by the State of Florida?
Insert college, major and year(s) attended
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Insert college, major and year(s) attended
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Insert college, major and year(s) attended
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What was your undergraduate grade point average (GPA)?
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Signature (insert name):
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