Application to Graduate Program
Semester
Last Name First Name Middle Initial Former Name Student ID
Educational Background
Undergraduate Degree Major Institution Term Graduated
Graduate Degree Major Institution Term Graduated
Current California Credential- Type of Credential Institution Date Expires
Application Requirements
1. Major Change form
2. Unofficial transcripts
3. Statement of Purpose
4. 2 Letters of Recommendation (including rubrics)
Please submit the completed application packet to the Department of Curriculum and Instruction, ED 250, email application to the program coordinator, or mail to:
Kremen School of Education and Human Development
Department of Curriculum and Instruction
Attn: Coordinator, Certificate of Advanced Study in Educational Technology
5005 North Maple Ave. M/S ED2
Fresno, CA 93740-8025
Home Phone # Cell Phone# Email
Certificate of Advanced Study in Research Methods
Statement of Purpose
Last Name First Name Middle Initial
In the space provided below (or an attached page), provide relevant information about yourself including goals, objectives, and experiences related to the master’s degree and/or advanced credential/certificate program to which you are applying. Please focus primarily on your short-term and long-term professional goals. You may attach additional pages. (1-2 pages maximum)
Last Name First Name Middle Initial
To the Applicant: Complete the information requested above and give to the person(s) providing the reference(s). Please note that, generally, confidential recommendations often provide more useful information. In accordance with the Family Education Rights and Privacy Act of 1974, the California Information Practices Act of 1977, and the related policies and regulations, it is also understood that upon request, this letter will not be made available to the applicant (or candidate) for examination. If you agree, you may sign the waiver below. The decision is up to you.
I waive the rights to see or inspect this form or any statement sent to the indicated program as a result of this request.
Signature ________________________________________________ Date ______________
Evaluator please complete the section below
The Kremen School of Education and Human Development would appreciate a statement from you evaluating the person named above for enrollment in and successful completion of an advanced credential and/or Master degree program. If additional space is needed, the back of this form may be used. Please provide the applicant with this form and a letter of recommendation in a sealed envelope with your signature across the seal.
Please rate the applicant with other individuals seeking comparable experiences.
Superior Above Average Below
Intellectual Ability
Imagination and Creativity
Interest and Enthusiasm
Ability to Communicate
Stability
If you alone were making the decision as to whether or not the applicant should be accepted, which of the following would you do?
Seek out Will be a truly outstanding student and professional
Definitely Accept Will complete the program at a superior level
Accept Should complete the program at a satisfactory level
Accept Accept, but with reservation concerning ability or motivation (please explain)
Do not accept Please explain
Signed Date Position
Contact Number Email
Letter of Recommendation Rubric
This rubric and a letter of recommendation is to be included with other application materials and submitted in one complete packet. Do not send separately.
Last Name First Name Middle Initial
To the Applicant: Complete the information requested above and give to the person(s) providing the reference(s). Please note that, generally, confidential recommendations often provide more useful information. In accordance with the Family Education Rights and Privacy Act of 1974, the California Information Practices Act of 1977, and the related policies and regulations, it is also understood that upon request, this letter will not be made available to the applicant (or candidate) for examination. If you agree, you may sign the waiver below. The decision is up to you.
I waive the rights to see or inspect this form or any statement sent to the indicated program as a result of this request.
Signature ________________________________________________ Date ______________
Evaluator please complete the section below
The Kremen School of Education and Human Development would appreciate a statement from you evaluating the person named above for enrollment in and successful completion of an advanced credential and/or Master degree program. If additional space is needed, the back of this form may be used. Please provide the applicant with this form and a letter of recommendation in a sealed envelope with your signature across the seal.
Please rate the applicant with other individuals seeking comparable experiences.
Superior Above Average Below
Intellectual Ability
Imagination and Creativity
Interest and Enthusiasm
Ability to Communicate
Stability
If you alone were making the decision as to whether or not the applicant should be accepted, which of the following would you do?
Seek out Will be a truly outstanding student and professional
Definitely Accept Will complete the program at a superior level
Accept Should complete the program at a satisfactory level
Accept Accept, but with reservation concerning ability or motivation (please explain)
Do not accept Please explain
Signed Date Position
Contact Number Email
Letter of Recommendation Rubric
This rubric and a letter of recommendation is to be included with other application materials and submitted in one complete packet. Do not send separately.
Student Data Sheet
Semester
Last Name First Name Former Name Student ID
FOR OFFICE USE ONLY
Faculty Review Notes
Certificate Program: Admit Deny
Admit Conditions:
Reasons Denial:
Home phone# Cell phone# Email
Certificate of Advanced Study in Educational Technology
Major change form
Unofficial transcript - 2.75 GPA requirement
Statement of purpose
2 letters of recommendation
Undergrad GPA _____
Postbac GPA _______
Last 60 Units GPA _____
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