Graduate Certificate in Institutional Research
Application Form for Admission to the IR Certificate Program

Please complete this form, "print" and mail it, along with all required documents, in ONE envelope to the address on page 1.

PERSONAL DATA:

Last Name
First Name
Middle/Maiden Name
Street Address
Street Address
City
State
Zip Code
Country
Citizenship
Permanent Phone
Current Phone
E-mail Address

EDUCATION:

Name of Institution
Major
Date Degree Granted
Name of Institution
Major
Date Degree Granted

PROGRAM INFORMATION:

Please select one of the following: I am requesting admission to

Enrollment into individual courses are limited; preference will be given to those admitted to the IR Certificate Program.

Admission to the 18-credit certificate program assumes knowledge of basic statistics. Those without a basic graduate level statistics course at the point of admission must plan on taking STAT 500 Applied Statistics as their first course and must plan on a 21-credit program for the certificate.

Please choose which course you would like to register for at this time

Certification Statement and Signature: I certify that the information submitted in this application and associated material is complete and accurate to the best of my knowledge. I understand that acceptance to this certificate program does not constitute admission to a degree program.

Signature: Date:



Check Sheet of Documents Needed:

_______ Official transcript from the institution awarding your highest degree.

_______ Your resume or employment history.

_______ A personal statement (include career goals, background, etc.).

_______ One letter of recommendation, with signature across seal.

_______ A copy of TOEFL test results.

SEND ABOVE DOCUMENTS TOGETHER IN ONE ENVELOPE TO:

Graduate Certificate in Institutional Research
College of Education - Higher Education
The Pennsylvania State University
400 Rackley Building
University Park, PA 16802-3203

 

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