TEXAS SOUTHERN UNIVERSITY
APPLICATION FOR ADMISSION TO THE GRADUATE SCHOOL

Social Security Number

Office Use Only MO DAY (Middle (City) (City)

Check the term of Entry (one box only Former name (State) (State)

Fall 

Spr 

Sum l 

Sum ll 

Legal Name (Last)

(First)

Sex (optional) (Zip) (Zip)

Date of Birth – Mo Day Year Home Phone Business phone

Mailing address (Number and Street) Permanent address (Number and Street) Place of birth (City) (State)

(County)

Are you a legal resident of Texas?  Yes  No

Are you a veteran?  Yes  No How long have you resided in Texas? From To

E-mail Address: Country of citizenship Type of visa if not US citizen

Ethnicity (Optional) This information is used for statistical purposes.  White Asian or Pacific Islander (AP)  Black/African American  Chinese  Samoan  Indian (American)  Filipino  Asian Indian  Japanese  Hawaiian  Korea Guamanian  Mexican American  Vietnamese  Other AP (Print group)  Latino  Other Race (please print) Name and address of parent or alternative contact

Have you previously applied for If yes, Year Department Admission to graduate status at  Yes  No Texas Southern University? Have you ever enrolled for If yes, From: To:  Undergraduate Student Student Number, if any credit courses at Texas  Yes  No  Graduate Student Southern University? List names of all colleges schools attended including Texas Southern University College or school name Location Dates Degree and date received or expected City State

Check box if you have taken or plan to take the following tests.  Graduate Record Examination  Test of English as a Foreign Language  Graduate Management Admissions Tests

Date Score:

List all jobs held during the past 12 months beginning with the most recent position. Name of Company, Agency of Organization City State Zip From: Mo. /Yr. To: Mo. /Yr.

Attach a sheet if additional space is required.

**Student Please Provide your E-Mail Address E-Mail Address:

APPLICATION FOR ADMISSION TO THE GRADUATE SCHOOL

Which student status are you seeking?

 Graduate

 Certificate
Teaching

 Transient Administration  Non Degree/Special Student

Check degree for which you wish to qualify.  M.A.  M.Ed.  M.B.A.  MUPEP  M.P.A. (Public Administration)  M.S.  Other Master’s (Specify)

Degree Goal:  Master’s Department State specified area in which you wish to study in you major department. If more space is required, attach separate sheet. Check ONE curriculum in which you wish to study (Master’s degree applicants) Administration of Justice  Biology Environmental Toxicology  Management Information Systems  Business Administration  Health Care Administration  Mathematics  Speech Communication  Chemistry  Health Education  Music Telecommunications  Computer Science  History  Psychology  Transportation Planning  Counseling  Human Performance  Pharmaceutical Science & Management  Curriculum & Instruction  Human Services & Consumer Science  Public Administration  Urban Planning  Educational Administration  Industrial Technology  Sociology  English  Journalism

Failure to submit complete and accurate information may result in denial of this application or dismissal from the University. Date Signature

DO NOT WRITE BELOW THIS LINE
DEPARTMENTAL RECOMMENDATION

Deficiencies that must be removed We recommend admission with the following status: 1. Unconditional  Conditional  2. Non-Degree (Special)  3. Non-Degree (Certificate)  4. Transient  5. Denied  Date Admitted Yes  No  Category of admission: Unconditional  Conditional  Non-Degree (Special)  Non-Degree (Certificate)  Transient  Denied  Date Signature of Departmental Representative
GRADUATE SCHOOL ACTION

Degree Sought Major Field Department

Major Code

Degree seeking status Remarks: 1.

Yes 

No 

Student notified: by letter  in person  Date

2. By Signature of School Dean

Notice of Nondiscriminatory Policy

Texas Southern University admits students without regard to their sex, disability, race, color, and creed, national or ethnic Origin and entitles them to all the rights, privileges, programs and activities generally accorded to its students. Texas Southern University does not discriminate on the basis of race, color, national or ethnic origin, sex or against otherwise qualified disabled students in its admission, academic and other standards, not in financial aid; nor in the planning and administration of any of its academic programs.