2012 17Work toward greatness.SCHOOL OF EDUCATIONAPPLICATION FOR GRADUATE NON-DEGREE STATUSTo apply and register as a Non-Degree student, you must:Contact the academic department listed below in order to schedule an advisement session and to obtain approval.
(You will need to provide a copy of your undergraduate and/or graduate transcripts.)Dyson College of Arts and SciencesCounseling (914) 773-3309 Environmental Science (914) 773-3655Forensic Science (212) 346-1967Media and Communication Arts (914) 773-3790Public Administration (914) 422-4299Publishing (212) 346-1431Psychology (212) 346-1506Submit the department-approved application and registration form with a non-refundable $70 check or money order to the appropriate
Office of Graduate Admission.Office of Graduate Admission Office of Graduate AdmissionPace University Pace UniversityOne Pace Plaza One Martine AvenueNew York, NY 10038-1598 USA White Plains, NY 10606-1932 USAPhone: (212) 346-1531 Phone: (914) 422-4283Fax: (212) 346-1585 Fax: (914) 422-4287E-mail: firstname.lastname@example.org E-mail: email@example.com 1. Name___________________________________________________________________________________________________________ Last First Middle 2. Female Male (Optional) 3. Current Mailing Address 4. Day Telephone (________) _____________________________ 5. Evening Telephone (________)_______________________________ Area Code / Number Area Code / Number 6. Fax (________)__________________________ 7. E-mail ________________________________ Area Code / Number 8. Please indicate the entry term for which you are applying: Fall _______ Spring _______ Summer I _______ Summer II _______ Year Year Year Year 9. At which campus location do you plan to attend classes? New York City Westchester 10. Have you previously applied to any graduate program of Pace University? Yes No If yes, please explain:________________________________________________________________________________________________________________________ 11. Please list in chronological order all institutions attended since your high school graduation.If I enroll in the Seidenberg School of Computer Science and Information Systems as a non-degree student, I confirm that I have the appropriate undergraduate course work or its equivalent for the courses in which I register. If I enroll in the College of Health Professions, Dyson College of Arts and Sciences, or School of Education, I confirm that I hold a U.S. bachelor's degree or its equivalent. My signature below further confirms that I do not require a student visa or exchange visitor's visa to attend graduate classes at Pace
University. I understand that I may enroll for a maximum of 12 credits as a non-degree student and that I am not guaranteed acceptance to a graduate program of Pace University.
I further understand that if I am accepted to a degree program, generally, credit for only two courses successfully completed as a non-degree student may be applied to a program.I certify that all of the information provided by me or on my behalf in support of my application for admission is complete and accurate. I acknowledge that I am obligated to supplement my application as soon as I know or reasonably should know if the information I have provided or that was provided on my behalf is inaccurate or incomplete. I also certify that the personal statement submitted in support of my application for admission is solely my own original work. I acknowledge that Pace University may, at its sole discretion, verify any information submitted in conjunction with my application. I acknowledge that if I omit relevant information or provide inaccurate information or
information that is misleading, submit a personal statement that is not solely my own original work, or of I fail to supplement my application as required, Pace University may, at its sole discretion, deny my application for admission, rescind my admission, impose disciplinary sanctions against me, dismiss me from Pace University, and/or rescind any degrees or certificates awarded to me by Pace University.I acknowledge that the application fee I have paid or will pay in the future is not refundable. I acknowledge that I am bound by the policies, rules, and regulations of Pace University, whether published or unpublished, and I agree to comply with them.Signature ____________________________________________________________ Date ___________/__________/__________ Month Day Year* Please be advised that your Social Security Number (SSN) is required for federal aid application processing. Your SSN will not be used for identification purposes at
Pace University. PLEASE COMPLETE REVERSE SIDEUndergraduate/Graduate
AwardedDate or Expected
Date of Degree//FEE REC DATE (MM/DD/YYYY)//DATA ENTRY DATE (MM/DD/YYYY)FOR OFFICE USE ONLY BY _____________ BY _____________College of Health Professions (212) 346-1439 (914) 773-3331Seidenberg School of Computer Science
and Information Systems (212) 346-1005 (914) 422-4191School of Education (212) 346-1338 (914) 773-3829
Work toward greatness.SCHOOL OF EDUCATION
REGISTRATION FORM FOR GRADUATE NON-DEGREE STATUS____ ____ ____-____ ____-____ ____ ____ ____ _________________________________________________________________________ U Number Last Name First Middle Fall _______ Spring _______ Summer I _______ Summer II _______ Year Year Year YearPlease provide information below. (Optional)DATE OF BIRTH ____/____/____ ETHNICITY (OPTIONAL): 1. African-American, non-Hispanic 2. Asian or Pacific Islander 3. Hispanic4. American Indian or Alaskan native 5. Caucasian, non-Hispanic 6. Other _______________________________ (please specify)EMERGENCY NAME: _______________________________________________________ RELATIONSHIP ___________________________ Last FirstEMERGENCY ADDRESS:_______________________________________________________________________________________________ _______________________________________________________________________________________________EMERGENCY TELEPHONE: (_________) __________________________I understand and agree that my admission, if granted, my registration and continuance on the rolls and graduation are subject to all policies, rules, regulations, and procedures set forth in the current bulletins, catalogs, and other publications, and notices of Pace University and as they may be amended, including but not limited with respect to scholarship, discipline, attendance, immunization requirements, and payment or abatement of fees.Signature _____________________________________________________________________ DATE _________/__________/_________ Month Day YearSAMPLE DAY COURSE R=THUR U=SUN REFERENCE NO. CRS CAMPUS NY/MT/WT/GC/PL/BR/OC SUBJECT COURSESAMPLE CHAIR GAS/GCS SIGNATURE DATE GDN/GED18 2009REG. OPERATOR'S SIGNATURE//DATE (MM/DD/YYYY)FOR OFFICE USE ONLY_____________________________________________________18 2012N Y X Y Z 100AM 99999 3