JACKSON STATE UNIVERSITY
Application for Graduate Admissions
(Please complete and mail)
1400 J. R. Lynch Street P.O. Box 17095 Jackson, MS 39217-0195

Enter all information that applies to you.


SECTION I

Date of application

Soc. Sec. No.

Name:
First MI Last

Other names under which transcript may be listed

Phone ( )

Present Address: (correspondence will be sent to this address)
Street and Apt. No.
City
State
Zip
County

e-mail Address:

Permanent Address: (Not a PO Box)

Street and Apt. Number
City
State
Zip
County

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*:

*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.


SECTION II

Field of Study/Concentration:

Degree Sought:

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:

Name of Institution
City and State
Attended from [Month/Year] to [Month/Year]
Degree Received/Major

Institution 2:
Name of Institution
City and State
Attended from [Month/Year] to [Month/Year]
Degree Received/Major

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)


SECTION III (International Students)

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.

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