Date of application
Soc. Sec. No.
Other names under which transcript may be listed
Phone ( )
Permanent Address: (Not a PO Box)
Place of Birth
Date of Birth
Mississippi Resident? Yes No
Gender: Male Female
Have you ever attended Graduate School at Jackson State University? Yes No
Will you transfer credits to Jackson State University? Yes No
Country of Current Citizenship:
Ethnic Group*: Select Nonresident Alien Hispanic/Latino American Indian/Alaska Native Asian Black or African American Native Hawaiian/Other Pacific Islander White Two or More Races Race and Ethnicity Unknown *This information is used for statistical purposes and to provide information required by the U.S. Department of Education in accordance with applicable federal regulations. You are not required to answer these questions; however, an answer would be appreciated.
Field of Study/Concentration:
Degree Sought: Select Doctoral Programs DrPH - Public Health EdD - Early Childhood Education PhD - Business PhD - Chemistry PhD - Clinical Psychology PhD - Educational Administration PhD - Environmental Science PhD - Public Administration PhD - Social Work PhD - Urban Higher Education PhD - Urban and Regional Planning Master of Arts MA - Criminology & Justice Services MA - English MA - History MA - Political Science MA - Sociology MA - Urban and Regional Planning Master of Science MS - Biology MS - Chemistry MS - Computer Science MS - Communicative Disorders MS - Community Counseling MS - Ed Administration &- Supervision MS - Engineering MS - Environmental Science MS - Hazardous Materials Management MS - Mass Communications MS - Mathematics MS - Rehabilitation Counseling MS - Sport Science Master of Arts in Teaching MAT - English MAT - Teaching MAT - Teaching Online Program Master of Science in Education MSEd- Early Childhood Education MSEd- Elementary Education MSEd- Physical Education MSEd- Reading Education MSEd- School Counseling MSEd- Secondary Education MSEd- Special Education MSEd- Technology Education Master of Science in Teaching MST - Mathematics MST - Science Education Education Specialist EdS - Ed Administration & Supervision EdS -Elementary Education EdS -Guidance and Counseling EdS -Secondary Education EdS -Special Education Master of Business Administration Master of Business Administration - Online Program Master of Professional Accountancy Master of Music Education Master of Public Health Master of Public Policy and Administration Master of Social Work Non Degree Seeking Status
Semester you wish to enroll: Fall Spring Summer 20
Have you previously applied to the Graduate School at Jackson State University? Yes No
List in chronological order all colleges and universities you have attended. (If more than three, attach separate sheet)
Institution 1:
Please indicate the highest degree earned:
Please indicate your enrollment intent at Jackson State University: To earn a Masters Degree To earn a Specialist Degree To earn a Doctoral degree To earn certification Workshop Only To update professional skills Other (specify)
Nation of citizenship Native Language
TOEFL Exam score has been will be submitted to Jackson State University.
Date__________ Applicant's Signature__________________________________________________
NOTE: Jackson State University recruits, admits and provides services, financial aid, and instruction to all students without regard to race, sex, religion, national origin or physical disability. Please review your information carefully. If it is correct, you may apply for admission to the Division of Graduate Studies at Jackson State University by completing this on-line application form or printing this application and mailing it with the requested documentation to: Division of Graduate Studies P.O. Box 17095 Jackson State University Jackson, MS 39217-0195 You must click on "Submit Form" below to send your Application for admission to the Division of Graduate Studies at Jackson State University. Please verify all information before sending. By sending this application you are certifying that the information hereon is complete, accurate and true to the best of your knowledge. Misrepresentation of facts hereon will be cause for refusal of attending.
Division of Graduate Studies P.O. Box 17095 Jackson State University Jackson, MS 39217-0195