North Carolina Central UniversitySchool of Graduate Studies • 214 Hoey Administrative Building • 1801 Fayetteville Street • Durham, NC 27707 • Telephone (919) 919-530-7396

Application For Graduate Admission

University regulations require that you attach a non-refundable application fee of $40.00. Please do not send cash. The feemust be in the form of a cashier's check, certified check, or money order, payable to North Carolina Central University.

INSTRUCTIONS:

a) Your application packet and a fourty dollar ($40.00) non-refundable application fee should be mailed to the School ofGraduate Studies (see address above). The fee must be in the form of a cashier's check, certified check or money order,payable to North Carolina Central University.

b) The application should be received in the School of Graduate Studies in each college and school at least 30 days (Arts andSciences/Library and Information Sciences) or 45 days (School of Business) prior to the beginning of the academicsemester in which entrance to the school is proposed. The School of Education has two admission deadlines: October 1st forspring admission and March 1st for fall admission. Applications received after the appropriate date will be considered for thenext entrance. The addresses for graduate programs are listed on page 2.

c) Please ask each higher educational institution you have attended for two (2) official transcripts of your academic record.Sealed transcripts should be mailed directly to you, and you should include the original sealed transcripts as part of yourgraduate school application package.

d) Also, please ask two persons who are familiar with your academic work to complete the enclosed Applicant EvaluationandRecommendation Forms. Whenever possible, one of these forms should be completed by the Chairperson of your

undergraduate major department (in the event you have been out of school for a number of years, two work references areappropriate).

e) International applicants who are graduates of institutions of higher education located outside the U.S.A. in non-Englishspeaking countries are required to demonstrate proficiency in the English language, generally by having official scores fromthe Test of English as a Foreign Language (TOEFL) submitted as part of your admission packet. International students mustalso have a Visa clearance form completed by the International Student Advisor at school currently attending or recentlyattended and a photocopy of I-20, I-94 and Visa page of current passport.

f) Applicants for the College of Arts and Sciences, School of Library and Information Sciences or School of Education mustinclude GRE scores. The MBA applicants must include a recent score from the GMAT, and a resume.

g) For School of Education applicants, please include a copy of your current teaching license if you are currently certified.h) Finally, two (2) self-addressed, 23 cent stamped cards (see perforations on cover flap):

1. Acknowledgement of Application Card 2. Complete/Incomplete Card.

Salutation (please type or print) Mr. Mrs. Ms. Miss Dr. Today's date _____ /_____ /_____

Name (type or print) _______________________________________________________________________________________Last First Middle

Other names under which you have registered at other schools or colleges (list) S.S.#: _______________________________

LastFirst Initial Last First Initial

Your Permanent or Parent's Address: _______________________________________________________________________________Street or Route City State Zip County

Your Present Mailing Address: ___________________________________________________________________________________Street or Route City State Zip County

Your Present Billing Address: ____________________________________________________________________________________Street or Route City State Zip County

Home Telephone ( ________ ) ________ - __________ Work Telephone ( _________ ) __________ - __________ Emergency Telephone ( ________ ) _________ - __________Name of nearest relative_________________________________________________________________________________

Last First Middle Relationship Area Code/Phone

Have you ever attended NCCU? Yes No If yes, date last attended _____ /_____ /_____

Undergraduate Major: ___________________________________________________________________________________Date of Birth _____ /_____ /_____ Sex (check one) Male Female

Federal regulations require institutes of higher learning who receive federal assistance to report enrollments by ethnic groups.This information is optional and cannot be used in a discriminatory manner.

ETHNIC ORIGIN ___________ (Please write appropriate number in space)

1. Caucasian (not of Hispanic origin) 2. Black (not of Hispanic origin) 3. American Indian or Alaskan native 4. Asian or Pacific Islander 5. Hispanic (regardless of Race)Nor

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CITIZENSHIP US Citizen Yes No Foreign Student Yes No Foreign students: If I - 20 form needed, please check here

VISA type_______________ exp. date Resident Foreign (Green Card) _______ Non-resident foreign _________

MILITARY STATUS Veteran Non-Veteran In Service Are you applying for Military Benefits? Yes No

Term of expected entrance Fall Spring Year__________ Expected degree________________________________

Entering as Full-time (9 or more hours) or Part-time (under 9 hours)? Do you plan to apply for Financial Aid? Yes No

Do you plan to live on campus? Yes No

HIGH SCHOOL AND COLLEGE INFORMATIONList all schools or colleges you have attended since high school graduation List the most recently attended first. Attach additional sheet if necessary:Name of School Address (City, State) From (Mo/Yr) To (Mo/Yr) Degree Earned Course or Major Year

WORK EXPERIENCE List all jobs you have held. Show most recent job first. Include all civilian and military experience.

Employer Job Title/Description Year

ON A SEPARATE SHEET OF PAPER:

Please discuss your academic objectives. Be specific with regard to the field in which you plan to study, contemplated research projects, and professionalplans. Your statement is an important part of your application. It will be carefully considered by the Committee on Admissions.

N.C. County Codes001 Alamance002 Alexander003 Allegheny004 Anson005 Ashe006 Avery007 Beaufort008 Bertie009 Bladen010 Brunswick011 Buncombe012 Burke013 Cabarrus014 Caldwell015 Camden016 Carteret017 Caswell018 Catawba019 Chatham020 Cherokee021 Chowan022 Clay023 Cleveland024 Columbus025 Craven026 Cumberland027 Currituck028 Dare029 Davidson030 Davie031 Duplin032 Durham033 Edgecombe034 Forsyth035 Franklin036 Gaston037 Gates038 Graham039 Granville040 Greene041 Guilford042 Halifax043 Harnett044 Haywood045 Henderson046 Hertford047 Hoke048 Hyde049 Iredell050 Jackson051 Johnston052 Jones053 Lee054 Lenoir055 Lincoln056 Macon057 Madison058 Martin059 McDowell060 Mecklenburg061 Mitchell062 Montgomery063 Moore064 Nash065 New Hanover066 Northampton067 Onslow068 Orange069 Pamlico070 Pasquotank071 Pender072 Perquimans073 Person074 Pitt075 Polk076 Randolph077 Richmond078 Robeson079 Rockingham080 Rowan081 Rutherford082 Sampson083 Scotland084 Stanly085 Stokes086 Surry087 Swain088 Transylvania089 Tyrrell090 Union091 Vance092 Wake093 Warren094 Washington095 Watauga096 Wayne097 Wilkes098 Wilson099 Yadkin100 Yancey

PROGRAMS OF GRADUATE DEGREES AWARDED BY NORTH CAROLINA CENTRAL UNIVERSITYPlease check desired area of concentration:

College of Arts & Sciences 919-530-6388P.O. Box 19467 Durham, NC 27707A. Master of Arts 4. Earth Sciences

1. English* 5. Human Science2. History* 6. Mathematics*3. Psychology 7. Physical Education*4. Sociology 8. Recreation Administration

B. Master of Science

C. Master of Public Administration1. Biology*2. Chemistry*3. Criminal Justice

School of Education 919-530-6478712 Cecil Street Durham, NC 27707A. Master of Arts B. Master of Education

1. Educational Technology 1. Elementary Education K-6*2. Agency Counseling 2. Middle Grades Education 6-9*3. Career Counseling 3. Communication Disorders*4. School Counseling w/ Licensure 4. Behavioral-Emotional Disabilities*

5. Mental Disabilities*6. Learning Disabilities*7. Visual Impairment*

School of Library and Information Sciences 919-530-6485P.O. Box 19586 Durham, NC 27707A. Master of Library Science B. Master of Information Science

1. Academic Library 1. Database Manager2. Archives/Records Management 2. Information Counselor3. Public Library 3. Information Network Manager4. School Library/Media Center 4. Institutional Researcher

(Including licensure) 5. Project Manager5. Special Library 6. Systems Librarian6. Juris Doctor/MLS 7. Other:________________________

Licensure1. School Media Licensure Only (Requires completed M.L.S. degree)2. School Media Licensure Renewal

School of Business 919-530-6493P.O. Box 19686 Durham, NC 27707

1. Master of Business Administration2. Juris Doctor/MBA

* May lead to M-level licensure. For more information, please contact the School of Education Admission to the College of Arts and Sciences, School of Education, and the School ofLibrary and Information Sciences requires a recent GRE score. Admission to the School of Business requires a recent GMAT score. Joint degree programs with the School of Law will requiretaking the LSAT and admission to the School of Law.

9. Computer and Information Sciences

Note: Falsifying or withholding information in completing this application is a violation of NCCU policies, and may constitute grounds for immediatewithdrawal of your application from consideration, or cancellation of your admission or registration.

APPLICATION RELATING TO CLAIMED NORTH CAROLINA RESIDENCE FOR TUITION PURPOSESThis residency form must be completed by all in state applicants only

North Carolina law (G.S. 116-143.1) requires that "To qualify as a resident for tuition purposes, a person must have established legal residence (domicile)in North Carolina and maintained that legal residence for at least 12 months immediately prior to his or her classification as a resident for tuition purposes."The information requested on this form must be supplied by every applicant for admission or readmission to North Carolina Central University who claimsto be eligible for the N.C. tuition rate. Complete the form and return it with your application for admission. This information is to be used only in connectionwith determination of your residence status for tuition purposes.

Tuition Benefits Notice: North Carolina provides benefits for spouses, family members and military dependants. Persons who quality for these benefits includespouse of North Carolina Residents, spouses of and depentants of active duty military personell stationed in North Carolina and family members of deceased ordisavled emergency workers. If you believe you quality for these benefits, you should contaact the Registrar's Office for a supplemental form. When youhavecompleted the supplemental form, please submit that form and a copy of your residency status application to the Registrat's Office.

The law requires that every student admitted to the University (initially or after a lapse in enrollment) be classified for the term admitted as either aresident or nonresident for tuition purposes, prior to enrollment. To be classified as a resident for tuition purposes, you must furnish such evidence asthe University may require to enable it to make such classification. If you claim North Carolina residence fur tuition purposes, you must file thisapplication promptly. Unless you are notified to the contrary in writing your classification in the University is non-resident for tuition purposes for yourproposed term of enrollment.

You must answer all questions on this sheet. Print or type your responses. For any inapplicable question, write N/A.If legal resident of NC, which county

(see code to side)? ________ If not, please give your home State or Country_____________

If legal resident of NC, how many years have you lived here (do not count time as a full-time college student)? ________ If you have been a legal resident of NorthCarolina for less than 12 months, provide any information you feel will support your request for North Carolina resident tuition status. Attach it to thisapplication.

__________________________________________________________________________________________________________________Full Name Soc. Sec. No. (voluntary)

__________________________________________________________________________________________________________________Age Date of Birth Place of Birth Citizenship

Current mailing address ______________________________________________________________________________________________________________________________________Number Street City State Zip

Until (date) _______________________________________ Te lephone ( ______ ) _______ - _________

Father living? Yes No His Name _____________________ Mother living? Yes No Her Name __________________________

If your parents are divorced, in whose custody are/were you? _______________________________________________________________Name of court-appointed guardian

(if applicable) ____________________________________________Location__________________________

Have you or either of your parents been in active military service within the past two years? Yes No

Check each of the following you have ever done outside North Carolina: Attended post-secondary school Worked

Secondary (high or preparatory) schools you attended in sequence (give school name, address, city, state, zip and dates you attended) :

School_______________________________________________ Address ________________________________________Attended from __________ to __________

School_______________________________________________ Address ________________________________________Attended from __________ to __________

School_______________________________________________ Address ________________________________________Attended from __________ to __________

TESTS & COURSES

1. If you have taken or will take one of the tests listed below, indicate date and score, if known. In addition, officialreports of scores must be sent to us by the Educational Testing Service. Our institution's number is 5495. My scores(check one) will be sent have been sent (give date):

2. What foreign language or languages can you read?

Number of foreign language hours:

3. Have you taken computer programming language courses? Yes No

If yes, Describe:

4. Have you taken statistics courses? Yes No

If yes, Describe:

5. Have you taken sign language courses? Yes No

If yes, Describe:

6. Cumulative grade point average in college:

Grade point average last 60 hours:Graduate school grade point average:Other:

Test Date Score %

a. Graduate Record Examination, Verbal Aptitudeb. Graduate Record Examination, Quantitative Aptitudec. Graduate Record Examination, Analytical Aptitude

d. Graduate Record Examination, Advance: Field ofStudy:e. Test of English as a Foreign Language (TOEFL) -

international students only

f. Graduate Management Admission Test (GMAT)g. Miller Analogyh. NTE/Praxis Core Battery

i. NTE/Praxis Specialty/Subject Area:

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Are you currently enrolled in college? Yes No If so, where?___________________________________________________

Give the permanent home address of each person listed below.

Street City State Zip Month and Year Moved There

YoursFather'sMother'sGuardian'sIf you had other N.C. addresses in the past 5 years, give the following information for those addresses:

Street City State Zip Lived There from (Date) - to (Date)

Yours _____________________________________________________________________________________________________________Give the last address outside N.C. for each person listed below:

Street City State Zip Lived There from (Date) - to (Date)

YoursFather'sMother'sGuardian'sAre you an Alien? No Yes If yes, please list Visa #______________________ and status of Visa ____________________________

If citizenship is other than US and you have Resident Alien status, enclose a photocopy of both sides of your I-551 ("Green Card").Was a North Carolina State Income Tax Return filed? Yes No What year? ______________________________________________

Listed personal property for taxation? Yes No

Note: Falsifying or withholding information in completing this application is a violation of NCCU policies, and may constitute grounds for immediatewithdrawal of your application from consideration, or cancellation of your admission or registration.

I certify that the above information is complete and correct, to the best of my knowledge, and understand that any willful misrepresentation of fact maybe cause for refused or canceled admission, or suspension from the university. Furthermore, I understand that any offer of admission is conditionalupon satisfactory completion of any course work in which I am currently enrolled, or in which I will be enrolled, prior to my matriculation at NCCU. Ifadmitted, I further agree to obey all rules and regulations of the university as stated in the student handbook, the university catalogue and other

university publications. My signature will release my records to the Registrar's Office for permanent record-keeping and to departmental advisors.I hereby acknowledge that the institution may verify the information set forth herein from sources accessible under law to the institution, pursuant to myreasonable inquiry where needed, but that institution may divulge the contents of this application only as permitted under the Family Educational Rightsand Privacy Act of 1974, if I am or have been in attendance at this institution.

I further state that if I have provided my social security number, I have done so voluntarily and with the understanding that it will be used only forstudent identification purposes.

_______________________________________________________ ______________________________________________________Signature Signature of Guardian if Applicant is Under 18 Years of Age

_______________________________________________________ ______________________________________________________Date Date

Thank you for applying to North Carolina Central UniversityIF ADDITIONAL INFORMATION IS NEEDED, THE APPLICANT WILL BE NOTIFIED.

North Carolina Central University is a constituent institution of The University of North Carolina, which is committed to equality of educational opportunity and does not discriminate againstapplicants, students, or employees based on race, color, national origin, religion, gender, age, or disability. Moreover, North Carolina Central University is open to people of all races andactively seeks to promote racial integration by recruiting and enrolling a larger number of white students.

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