Graduate Admission Application

Information / Instructions

We are pleased that you have requested application materials from Governors State University. We recommend that you review all program

requirements carefully. Major requirements may vary. Please review the speciﬁc requirements in the GSU catalog or on our website at

www.govst.edu/catalog, or on the speciﬁc program fact sheet to verify additional admission requirements. Some departments require

that applicants submit a statement of career goals, letters of recommendation, GMAT/GRE scores, portfolios, etc. There is a $50 non-

refundable application fee for graduate applications. Please enclose a check or money order, made payable to Governors State University.

The $50 non-refundable application fee is waived for applicants who are veterans of or on active duty in the U.S. Armed Forces. Please

contact the Ofﬁce of Admission for further information. Applications will not be processed until the application fee has been received.

All applicants must have or will have earned, by the term they wish to enroll, a baccalaureate degree from a regionally-accredited

institution of higher education. Applicants must be in good standing at the last institution attended, including Governors State University,

and they must satisfy any applicable special program admission requirements as described in the catalog.

TRANSCRIPTS

Applicants are required to submit ofﬁcial transcripts to the

Ofﬁce of Admission and Student Recruitment. If transcripts

are hand carried into the university, they must be in a sealed

envelope. If you have course work in progress, you are required

to submit a supplemental transcript upon completion of the

course work. Some programs may require an additional set of

transcripts sent to that speciﬁc program. Photocopies of

transcripts are not acceptable.

SUPPLEMENTAL ADMISSION DOCUMENTS

Refer to the GSU catalog at www.govst.edu/catalog to verify

requirements and additional documents needed.

MAIL APPLICATION AND DOCUMENTS TO:

Governors State University

Ofﬁce of Admission

1 University Parkway

University Parkway, IL 60484

For more information, call 708.534.4490.

ADMISSION COUNSELING

If you would like additional information regarding admission

to Governors State University or you would like to speak to an

admission counselor, please contact the Ofﬁce of Admission at

708.534.4490.

You may also visit www.govst.edu/admission for more information

or to apply online. There are a variety of events taking place

throughout the year aimed at providing admission and ﬁnancial

aid information to prospective students.

GRADUATE EXAMINATIONS

If the department requires a standardized test, such as GMAT/

GRE, applicants must request that their test scores be sent to

the Ofﬁce of Admission by the testing agency. The institutional

code for GSU is 1263. It is suggested you take the graduate

admission examinations three months before the intended term

of enrollment to ensure that the scores arrive in time.

CONTACT INFORMATION

GRE

www.gre.org

Governors State University Code: 1263

GMAT

www.mba.com

Governors State University Code: WSR-96-73

SELF-MANAGED APPLICATIONS

The departments that require a self-managed application are

shown without an asterisk. Applicants to self-managed programs

are required to submit a complete application packet. The

application packet should include all required admission

materials (such as ofﬁcial transcripts, letters of recommendation,

personal statement, resume, etc. All documents for self

managed applications must be submitted at the same time to

the Ofﬁce of Admission.

PROSPECTIVE APPLICANTS WITH

DISABILITIES

Applicants with a disability are encouraged to contact the

Academic Resource Center at 708.534.4508 for further

assistance.

708.534.4490 • [email protected] • www.govst.edu/admission

Online application available at applynow/govst.edu

Graduate Admission Application

Degree Programs and Major Codes

COLLEGE OF ARTS AND SCIENCES (CAS)

Accounting (ACCT.MS)

Business Administration (BSAD.MBA)

Supply Chain Management (BSAD.SCMO.MBA)

Management Information Systems (MIS.MS)

Public Administration (PADM.MPA)

COLLEGE OF BUSINESS AND PUBLIC

ADMINISTRATION (CBPA)

COLLEGE OF EDUCATION (CE)

COLLEGE OF HEALTH AND HUMAN

SERVICES (CHHS)

Counseling

Clinical Mental Health (COUN.CMH.MA)

Marriage and Family (COUN.MF.MA)

School Counseling (COUN.SCH.MA)

Early Childhood Education (EDEC.MA)

Education

Bilingual/ESL Education (EDUC.BESL.MA)

Computer Education (EDUC.CPE.MA)

Curriculum and Instruction (EDUC.CI.MA)

Mathematics Education (EDUC.MTE.MA)

Science Education (EDUC.SCI.MA)

Educational Administration

Principal Leadership (EDAD.PRIN.MA)

Chief School Business Ofﬁcial (EDAD.SBO.MA)

Higher Education (EDAD.HED.MA)

Multicategorical Special Education (MCSE.MA)

Reading (READ.MA)

Psychology (PSYC.MA)

Clinical (PSYC.CLN.MA)

Theoretical (PSYC.THS.MA)

Urban Teacher Education (UTED.MAT)

School Psychology (SPSYC.EDS)

Education Specialist Degree

* Addiction Studies (ADDS.MHS)

** Communication Disorders

** Health Administration

** Nursing

** Occupational Therapy

Social Work (SOCW.MSW)

Applications are available from the Ofﬁce of Admission and Student Recruitment. Please check below for the major code for which you

will be applying. Enter the appropriate code in Major Code portion of the application. This information is essential for the processing of

your application. For complete admissions requirements and application deadlines, please see the GSU catalog. Applications, catalogs

and additional information are also on the website at www.govst.edu.

** Please note some graduate programs may not apply using this application. **

* Analytical Chemistry (ANCH.MS)

Art (ART.MA)

Communications and Training

Communication Studies (COMT.COM.MA)

Human Performance and Training (COMT.HPT.MA)

Media Communications (COMT.MDC.MA)

* Computer Science (CPSC.MS)

Criminal Justice (CJUS.MA)

English (ENGL.MA)

* Environmental Biology (ENBI.MS)

Independent Film and Digital Imaging (IFDI.MFA)

Political and Justice Studies (POJS.MA)

COLLEGE OF ARTS AND SCIENCES

COLLEGE OF EDUCATION

* NO Supplemental documents required

** These programs use the CAS application which is found only online at our website, www.govst.edu.

Please visit the program website to access the application.**

Graduate Admission Application

Additional Information

CAMPUS SAFETY

Governors State University is committed to maintaining a safe environment for all members of the University community. As part of

this commitment, the University requires all applicants to disclose pending criminal charges or criminal convictions, or educational

disciplinary separation from an educational institution by answering the six Campus Safety Questions below. The completion of the

Campus Safety Questions is a mandatory part of the Governors State University admissions process. Applications in which an applicant

answers ‘yes’ to any of the Campus Safety Questions will be reviewed by the University prior to an admission decision.

Governors State University does not necessarily deny admission simply because an applicant has a history of criminal or civil offenses

or disciplinary matters. In making admission decisions, GSU considers a number of factors, including, but not limited to, the nature,

number, and date of offenses in light of the requirements for participation in its programs. If you do not disclose your complete history

here, regardless of your reason, GSU may, upon discovering your failure to disclose, subject you to discipline up to and including denial

of admission, revocation of admission, suspension or dismissal after matriculation, or revocation of degree.

SECURITY INFORMATION NOW AVAILABLE

GSU is committed to assisting all members of the community in providing for their own safety and security. The annual security

compliance document is available on the GSU website at www.govst.edu/cleryact. The website contains information on campus security

and personal safety, including crime prevention, university police law-enforcement authority, crime reporting policies, disciplinary

procedures, and other important matters about security on campus. It also contains statistics for the three previous calendar years on

reported crimes that occurred on campus, in certain off-campus buildings or property owned or controlled by GSU, and on public property

within or immediately adjacent to and accessible from the campus. This information is required by law and is provided by the GSU’s

Department of Public Safety.

____ Sign your application

____ Submit the application form

____ Submit your $50 application fee

____ Send an ofﬁcial transcripts from all colleges attended

____ Submit supplemental documents, if applicable

____ Submit test scores, if applicable

____ Mail complete application packet to:

Governors State University

Ofﬁce of Admission

1 University Parkway

University Parkway, IL 60484

APPLICATION CHECKLIST

PA048413

Governors State University is an afﬁrmative action/equal opportunity university which administers its educational and employment

programs in compliance with federal, state, and local laws and does not discriminate on the basis of race, color, national origin,

religion, gender, ancestry, age, sexual orientation, marital status, disability, citizenship, unfavorable discharge from military service

or veteran status.

❑ Mr. ❑ Mrs. ❑ Ms. ❑ Other__________

Name __________________________________________________________________________________________________________________

Last First M.I.

Permanent Address ______________________________________________________________________________________________________

Number & Street Apt.#

_______________________________________________________________________________________________________________________________________

City or Town State ZIP Code + 4 Country

Mailing Address (if different from above)

_______________________________________________________________________________________________________________________________________

Number & Street Apt.#

_______________________________________________________________________________________________________________________________________

City or Town State ZIP Code + 4 Country

Home Phone ( ) __________________________________ Work Phone ( ) ______________________________________________

Email _________________________________________________ Cell Phone ( ) _______________________________________________

Birthdate ______________________________________ ❑ Male ❑ Female Previous Name(s) __________________________________

Month Day Year

Ethnic Origin:

1. Are you Latino/Hispanic? No ____ Yes ____ 2. Please select the categories below that describe you (select as many as apply)

❑ American Indian or Alaska Native ❑ Native Hawaiian or Paciﬁc Islander

❑ Asian ❑ White

❑ Black or African American

Illinois Resident? ❑ Yes ❑ No How long? ___________Years __________Months County_____________________

Citizenship Status: ❑ U.S. Citizen ❑ Permanent Resident (attach copy of permanent residency card, both sides.)

❑ Undocumented/Deferred Action

Please indicate your military status: ❑ No Military Service ❑ Active Duty ❑ Active Reserve ❑ National Guard

❑ Inactive Reserve ❑ Veteran ❑ Dependent or Survivor of a Veteran

Graduate

Application for Admission

—over —

PLEASE PRINT OR TYPE

Social Security Number* — —

*Your Social Security Number (SSN) is requested pursuant to Public Law 93-579 for the University’s system of student records, as well as for compliance with federal and

state reporting requirements. Your SSN is required if you are applying for ﬁnancial aid but is not required for admission to the University. Providing an SSN will, however, speed

up the processing of your application since we will not need to manually match your application with other materials such as transcripts and test scores. Supplying your SSN

ensures that you will be able to claim the Hope Tax Credit, if you are eligible, on your federal tax return. The University has a strong commitment to ensuring the privacy and

conﬁdentiality of student records and will not disclose your SSN without your consent for any purpose except as allowed by law.

Please read the accompanying instructions before completing this application. Please refer to the code sheet on the previous page for all

appropriate codes.

Applying for: ❑ Fall (August-December) ❑ Spring (January-May) ❑ Summer (May-August) Year____________________

Applying as: ❑ New Student ❑ Readmission

Major Code (see list on page 2) ____________________________________________

Have you ever applied to GSU before? ❑ Yes ❑ No If yes, indicate year_______________

Have you ever attended GSU? ❑ No ❑ Yes, when ________________ GSU ID# ________________________

Online application available at

https://applynow.govst.edu

________________________________________________________________________________________________________________________

Signature Date

You must list all colleges or universities attended. Use reverse chronological order, beginning with the most recent, including GSU.

Continue on a separate page if necessary.

If you have attended GSU before, did you leave in good academic

standing? ❑ Yes ❑ No ❑ Not Applicable

Are you in good standing at the college or university last attended?

❑ Yes ❑ No If No, see below.

Note: Applicants not in good standing at the last college attended,

including GSU, must petition for admission under the Policy on

Readmissions and Special Admissions. This petition can be printed from

the website at www.govst.edu/apply. All petitions to the committee must

be submitted in writing to the Ofﬁce of Admission. A typed letter of

petition must accompany the application for admission and all required

application materials, including, ofﬁcial transcripts.

• Extenuating circumstances or hardships that may have caused the

student to earn poor grades

• Preparation for proposed program of study, prerequisite coursework

achieved, and/or work experience equivalent to college level study

• Actions taken by the applicant which provide evidence of experience and

knowledge of the desired major

The letter of petition should explain any of the situations above that may

apply to the student’s experience.

Name/Campus City State Entered Left Degree or Hours Date Received or

Mo. Yr. Mo. Yr. Earned Expected

Governors State University is an equal opportunity institution. The university adheres to Section 504 of the Rehabilitation Act.

This application must be signed and dated by the applicant and returned with required application fee before action can be taken.

I understand that withholding information requested or giving false information on this application may make me ineligible for admission

to the university or subject to dismissal. I certify that the information provided on the application is correct and complete.

For Ofﬁce Use Only GRAP Cash ____ Check ____ Received by____________

Do you certify the following?

I understand that once my application has been submitted it may NOT be

altered in any way. ❑ Yes ❑ No

I certify that all of the information submitted in the application is my own

work, factually true, and honestly presented. I understand that I may be

subject to a range of possible disciplinary actions, including admission

revocation or expulsion, should the information I certiﬁed be false.

❑ Yes ❑ No

I understand that an offer of admission is conditional, pending receipt of

ﬁnal transcripts showing work comparable in quality to that upon which

the offer was based. ❑ Yes ❑ No

CAMPUS SAFETY

For the purpose of the following four questions ‘crime” or ‘criminal

charge” refers to any crime in which the offender is considered an adult,

other than a trafﬁc related misdemeanor or an infraction or criminal

offense that is sealed/expunged/pardoned or otherwise protected from

disclosure by express authority of law. You must, however, include alcohol

or drug offenses whether or not they are trafﬁc related.

1. Have you been convicted of a crime? ❑ Yes ❑ No

2. Have you entered a plea of guilty, a plea of no contest, a plea of nolo

contendere or an Alford plea, or have you received a deferred prosecution

or prayer for judgment continued to a criminal charge? ❑ Yes ❑ No

3. Do you have any criminal charges pending against you? ❑ Yes ❑ No

4. Have you ever been expelled, dismissed, suspended, placed on

probation or otherwise subject to any disciplinary sanction by any school,

college or university? ❑ Yes ❑ No

In addition to the truthful, accurate and complete completion of the

Campus Safety Questions, an applicant must promptly notify the Ofﬁce of

Admission in writing of any criminal charge, any disposition of a criminal

charge, or any school, college or university disciplinary action against the

applicant, or any type of military discharge other than an discharge under

honorable conditions that occurs at any time after you submit this

application to Governors State University. Your failure to do so will be

grounds to deny or withdraw your admission or make you subject to

disciplinary sanctions after enrollment.

If you answered “yes” to any of the four Campus Safety Questions above

please explain the circumstances below, including the following information

for review of the Readmission or Special Admission Committee at

Governors State University. Information, including:

• A brief explanation of the criminal offense(s) or pending criminal charge(s)

• Date(s)

• Location (city, state, county)

• Case Number(s)

• Court Disposition

should be sent at the time of application for admission, in a Statement,

typed in English, dated and including your signature to:

READMISSION AND SPECIAL ADMISSIONS COMMITTEE

Ofﬁce of Admission

Governors State University

1 University Parkway

University Park, IL 60484

The university will not consider an application complete until the required

Statement is received and included in your admission ﬁle. If, after review-

ing your Statement the university determines it needs to gather additional

information before making a decision on your application the university

reserves the right to request a release from you for the release of original

court, military or educational disciplinary records in making an admission

decision.