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2012 5Pace University Application for Graduate AdmissionComplete and return the application along with the $70 non-refundable application fee. Please print neatly using blue or black ink or type.School of EducationMSEd in Educational Leadership (Fall entry, New York City only)MSEd in Educational Leadership (Spring entry, Westchester only)Please indicate your degree or certificate objective:MS for Teachers (Business and Marketing Track)MS for Teachers (Visual Arts Track)Advanced Certificate in Teaching (Adolescent Track)Advanced Certificate in Educational Technology SpecialistCome Teach with Us (Westchester only)Advanced Certificate in Adolescent Special EducationAdvanced Certificate in Childhood­­ Special EducationAdvanced Certificate in Literacy SpecialistAdvanced Certificate in Autism and Severe or Multiple Disabilities (New York City only) MSEd in Educational Technology SpecialistMSEd in Special EducationMSEd in Literacy Specialist (Westchester only)MS in Educational Technology StudiesMST for Teaching Childhood or AdolescentMST for Teaching Childhood and Childhood Special EdSubject Area:Subject Area:Mr.Ms.Last NameFirst NameMiddle NameJr., III, etc.Mailing AddressApt. #CityStateZip/Postal Code()-Home Phone NumberE-mail AddressIf any records will be under another name(s), please indicate.CountryAddress 2()-Business Phone Number()-Fax Number--Social Security Number*//Date of Birth (MM/DD/YYYY)* Please be advised that your Social Security Number is required in order for your Free Application for Federal Student Aid (FAFSA) to be processed. Your SSN?will not be used for identification purposes at Pace University.Gender MaleFemaleInternational applicants who will require a student visa must apply for full-time study.Have you previously applied to or enrolled in any school or program of Pace University?YesNoIf yes, please explain (include school, program, and entry term date):Are you Hispanic/Latino? Yes, Hispanic or Latino (including Spain) No If yes, please describe your background_______________________________If you answered No, or if you answered Yes and wish to describe yourself further, please check one or more from the list below. American Indian or Alaska Native (including all Original Peoples of the Americas) Are you enrolled in a Tribe? Yes No If yes, please enter Tribal Enrollment Number Asian (including Indian subcontinent and Philippines) Black or African American (including Africa and Caribbean) Native Hawaiian or Other Pacific Islander (Original Peoples) White (including Middle Eastern) Other______________________________________________________ Ethnicity (optional)Is English your native language?YesNoNative language (if other than English) _______________________________________________________________________Campus:New York CityWestchesterSemester:FallSpring 20Status:Full-TimePart-TimeSummer ISummer II If accepted for graduate study, will you need campus housing?YesNo

6 2012If applicable, please indicate when the Test of English as a Foreign Language (TOEFL) was or will be taken: /TOEFL Date (MM/DD/YYYY)Are you a citizen of the United States? YesNoAre you a permanent resident of the United States?YesNoIf you are not a U.S. citizen or permanent resident, please complete the following: If accepted for admission to Pace University, will you need a Certificate of Eligibility (I-20) for a student visa? If no, please indicate visa status you hold or will hold: If yes, please provide the information below: YesNoVisaOccupation in your home countryCity of birth Country of birth Country of citizenship Are you or an immediate family member an employee of Pace University?YesNoIf yes, please explain:Current employerAre you now in the USA?YesNoIf yes, please indicate your present visa status below and provide your home country address:Visa statusCity StateCollege / Organization / EmployerHome Country Address:Please explain here if this visa status expires prior to your anticipated Pace University enrollment date:(Please note: If you do not provide this information we cannot process your I-20)Will dependents accompany you in the U.S.?YesNoIf yes, please provide information below: ­(Please attach information regarding additional dependents who will accompany you.)Last NameFirst NameMiddle Name//Date of Birth (MM/DD/YYYY)City of birth Country of birth Relationship to studentP­­­­­­­­­­­­­­­­lease provide the information below:Does your employer provide tuition reimbursement?YesNoCityStateCountryWhich of the following was the biggest influence in your decision to apply to Pace University? (Check the appropriate box):Accelerated Admission Day Event Attended a Pace Information SessionCampus LocationCareer Services and Internship ProgramCollege or Professional FairCourse OfferingsFinancial Aid/Scholarship OfferingsInformation on Pace websiteOnline Chat with Department/AdmissionsPhone or in-person meeting with Pace Admission CounselorSchool Publication received in the mailRecommendation from current Pace StudentRecommendation from Pace AlumniRecommendation from Pace Faculty/Staff MemberRecommendation from EmployerTour of Pace University campusAttended a Special Event with a chosen program