Mercer University

Application for Tift College of Education Graduate Admission

First Name, Middle Initial
Last Name
Previous Last Names
Social Security Number
Birthdate (mm-dd-yyyy)
Gender
Address
Address (line 2)
City
State
Zip code
Country or Province
E-mail Address
Home Phone Number
Cell Phone Number
(Optional; Used for statistical reporting purposes only)
Are you Hispanic or Latino? Yes, I am of Hispanic/Latino Origin. No, I am not of Hispanic/Latino Origin
  Includes all persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member: White Asian
Black or African American No Response
American Indian/Alaska Native    
Native Hawaiian or other Pacific Islander
Religious Preference: Baptist Islam/Muslim
  Methodist Evangelical
  Presbyterian Hindu
  Episcopalian Buddist
  Catholic No Preference
  Lutheran Other
  Jewish No Response
Citizenship Type


Location that you wish to attend
Please select a program
Desired Year of Entrance
Desired Semester of Entrance Semester:
Application Type
Please select one, required
I have attended Mercer before and wish to be readmitted.

Employer Information
Name of Employer:
Position:
Address:
City:   Zip:  
Phone:
Does your employer provide financial assistance?
  
Are you a member or veteran of the U.S. Armed Forces?
  
If yes, give branch and dates of military service:
(Most veterans may receive credit for military service experience by filing a copy of their DD Form 214; those on active duty may receive credit by filing a copy of their DD Form 295.)
Have you ever been placed on probation at any college, university, or technical school?
  
If yes, what quarter/semester and year were you placed on probation?
At which college?
Have you ever been suspended, excluded or dismissed from any college, university, or technical school?
If yes, please indicate the name of the school dates, and explain the situation:
Please give the source of your interest in Mercer University: Alumni
Student
Friend
Center Coordinator
Instructor
Brochure
Flyer
Presentation		 Educational Fair
Company Visit
Newspaper Ad
TV Commercial
Radio
Internet
Other
   
If you would like to recommend a friend to Mercer University, please complete the information below:
Name:
Address:
Address (line 2):
City:   Zip:  
Phone Number:
   
   
Fee-Waiver Code:
   
* I certify that the information provided in this application is true and correct to the best of my knowledge.  I agree that, if accepted, I will abide by all the rules, procedures, and policies of the University, now and hereafter adopted, as set forth in the University Bulletin, the Code of Conduct for Students, and the Honor System.  I understand that falsification or misrepresentation of information in any admission document is grounds for denial of admission or may result in dismissal from Mercer University.

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3001 Mercer University Drive, Atlanta, GA 30341
1250 East 66th Street Savannah, GA 31404
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