Averett - Online Application

Averett University
Application for Graduate Admission

Personal Information

First Name *

Middle Name

Last Name *

Suffix

Maiden Name

Preferred Name

Date of Birth (MM/DD/YYYY) * +

Gender *

Male

Female

Other

Home Phone (XXX-XXX-XXXX) *

Cell Phone (XXX-XXX-XXXX) *

Email Address *

Address (No P.O. Boxes) *

City *

State *

Zip Code *

Country

Optional Demographic Information

Federal and state agencies request that we supply demographic data on applications for admission to Averett University. To enable us to comply with these requests, we ask that you complete this optional section. If you choose not to answer any part of this section, it will in no way affect your admission
to Averett.

The VA Certifying Official for Averett University will determine the Chapter for those eligible for military benefits.

Military Status (if applicable)

Active Duty

Veteran

Marital Status:

Religion

First Generation Student:

Yes

No

Do you intend to file a FAFSA?

Yes

No

Are you of Hispanic/Latino Ethnicity or Descent?

Yes

No

Ethnicity:

Citizenship Information (Outside of the USA)

Permanent U.S. Residents must submit a copy of their Permanent Resident Card.

Are you a US Citizen or Permanent Resident? *

Yes

No

Primary Country of Citizenship:

Primary Language:

If English is not your first language, you must submit official TOEFL scores.

Test Type:

TOEFL

TOEFL Electronic

Test Score:

Test Date (MM/YY):

Academic Information

Start Term *

Spring 2022

What Degree are you interested in Obtaining? *

M.Ed. - Curriculum & Instruction - Educational Foundations

M.Ed. - Curriculum & Instruction w/ Reading Specialist Endorsement

M.Ed. - Curriculum & Instruction w/ English as a Second Language Endorsement

M.Ed. - Curriculum & Instruction w/ Gifted Education Endorsement

M.Ed. – Special Education General Curriculum, K-12 Virginia Endorsement Track

M.Ed. – Special Education General Curriculum, K-12 Virginia Licensure Track

M.Ed. in Administration & Supervision, Virginia Endorsement Track

Employment

For verification of employment, please complete the following for each place of employment (the MEd in Administration and Supervision program requires 3 years full-time work experience as a primary or secondary classroom teacher, MEd in Curriculum & Instruction requires 1 year full-time work experience
as a primary or secondary classroom teacher).

Current Employer *

Phone Number *

Status *

Part Time

Full Time

Start Date * +

Presently Employed Date or Last Date of Employment * +

Former Employer

Phone Number

Status

Part Time

Full Time

Start Date +

Last Date of Employment +

Education History

Please list all colleges/universities that you have attended. If you are a transfer student, please list your last college attended first.

College/University Name *

City *

State *

Begin Date * +

End Date * +

Degree Earned *

College/University Name

City

State

Begin Date +

End Date +

Degree Earned

College/University Name

City

State

Begin Date +

End Date +

Degree Earned

Final Cumulative Bachelor’s GPA (Please note: A minimum GPA of 3.0 is required.) *

If you are unsure of your GPA please estimate. Once transcripts arrive we will update our system with the official GPA.

Additional Questions

Would you be interested in receiving text messages in reference to the status of your application? *

Yes

No

Do you have any relatives that attended Averett University *

Yes

No

If yes, please share their information.

Name *

Relationship *

Year *

Have you ever been convicted of a crime in any state? *

Felony

Misdemeanor

No

If yes, please give a brief description (an enrollment counselor will contact you): *

Signature

Please validate the below statements and provide your signature and date.

Agreements:
1. You agree to have computer access with word processing, graphical presentation software, spreadsheet capabilities and internet connectivity for academic use.
2. You acknowledge that Averett University reserves the right to change academic content, sequence and tuition fee schedule at any time.
3. You certify that you meet the work experience requirement for admission into the Graduate and Professional Studies Program.

I confirm that I have reviewed all the information on this application form and have found it to be accurate. By selecting “Yes”, you attest that all the information provided is true and complete to the best of your knowledge and that you understand that false information will jeopardize your admission to and continuation in these Averett Programs. *

Yes

No

Student Signature *

Date (mm/dd/yyyy) * +

Verification *
captcha

Never married	Married
Separated	Divorced
Widowed

American Indian or Alaska Native	White
Black or African American	Asian
Native Hawaiian or Other Pacific Islander	Prefer to not respond