Apply to the Master's Programs in Education and Teaching

NOTE: You will need to complete this form within 30 minutes of starting it. We would recommend printing it out, and then typing up the answers that require text input. Then you can cut and paste the information into the form rather than trying to complete it in 30 minutes. This particularly applies to the “Professional Coursework” and “Essay” sections. IF YOU ARE HAVING ISSUES WITH THE RECAPTCHA VERIFICATION AT THE BOTTOM OF THE FORM, PLEASE TRY AGAIN IN A DIFFERENT BROWSER, LIKE CHROME OR FIREFOX.

Enrollment Information

Select a program:

MAT Secondary Education Subject Area (if chosen above)

Start Date (mm/dd/yyyy)

Choose an enrollment preference:

Student Information

Salutation:

Salutation

Mr. Ms.

First Name:

Middle Name:

Last Name:

Preferred Name:

Date of Birth (mm/dd/yyyy):

Place of Birth:

Contact Information

Email:

Home Address:

City:

State (e.g. VA):

ZIP:

Country:

Mailing Address (if different):

City:

State (e.g. VA):

ZIP:

Phone:

Cell Phone:

Employment Information

Employer:

Current Position:

Work Phone:

Work Fax:

Licensure Information

Do you currently possess a valid teaching license?:

Do you currently possess a valid teaching license?

YesNo

Citizenship Information

Are you a U.S. citizen?

YesNo

If NOT, please answer the following:

What is your country of citizenship?

Are you a permanent U.S. resident?

YesNo

Number of years you’ve spent in the U.S.

Is English your first language?

YesNo

Language

What is your first language, if other than English?

What language do you speak at home?

Gender, Identity, Race, Religion

Ethnicity

Race

Legal Gender

Gender Identity

Pronoun

Religion

Degree Information

Do you have a bachelor’s degree?

YesNo

If you have a BA, what was your Major?

Do you have an associate’s degree?

Do you have a bachelor’s degree?

Yes No

Name of granting institution for your degree:

Date you completed (or will have completed) your degree (mm/dd/yyyy):

GPA at time of application (if known):

Test Scores

PRAXIS/CASE

Total:

Reading:

Writing:

Math:

Date Taken (mm/dd/yyyy):

VCLA

Total:

Reading:

Writing:

Date Taken (mm/dd/yyyy):

SAT

Total:

Verbal:

Math:

Date Taken (mm/dd/yyyy):

ACT

Composite Score:

Date Taken (mm/dd/yyyy):

Professional Coursework

Please list/describe any professional courses you have completed along with any grades you received.

Colleges/Universities Attended

College/University 1:

College/University 1 City:

College/University 1 State:

College/University 1 Dates of Attendance (mm/dd/yyyy to mm/dd/yyyy):

College/University 2:

College/University 2 City:

College/University 2 State:

College/University 2 Dates of Attendance (mm/dd/yyyy to mm/dd/yyyy):

College/University 3:

College/University 3 City:

College/University3 State:

College/University 3 Dates of Attendance (mm/dd/yyyy to mm/dd/yyyy):

High School Attended

High School Name:

High School City:

High School State:

Graduation Year:

GED:

GED City:

GED State:

GED Date Awarded (mm/dd/yyyy):

Please provide your former name(s) at the time of attendance at the above institutions that will appear on transcripts from these institutions:

How did you learn about the master’s programs at Randolph?:

Essay

Please submit a written statement of 500 words describing your educational goals and your reasons for entering the master’s degree program. This statement may be mailed separately or submitted via e-mail to admissions@randolphcollege.edu. If you are submitting separately, please indicate that in the box below.

Verification: