NORTH CAROLINA CENTRAL UNIVERSITY DURHAM, NORTH CAROLINA 27707 APPLICATION FOR ADMISSION TO THE SCHOOL OF LIBRARY AND INFORMATION SCIENCES PASTE/STAPLE PHOTOGRAPH HERE Optional

Please check desired degree and, if MLS, area of concentration: ___ Master of Information Science ___ Master of Library Science ___Academic Library ___ Archives/Records Management ___ Public Library ___ School Library/Media Center (including certification) ___ Special Library ___ Joint Juris Doctor with the NCCU School of Law (Requires admission to NCCU School of Law) ___ School Media Certification Only (requires MLS degree) ___ School Media Certification Renewal

Office Use Only ___Admitted: ___ Conditional Admission ___ Probationary Admission ___ Special Student ___ Not Admitted Advisor: _______________ Dean: _________________ Admission Date: _________ Received: Application ____ Transcripts (2) ____ Recommendations (2) ____ Residency Form ____ Health Form ____ Application Fee ____ Financial Certificate____ G.P.A.____ G.R.E.____

SOCIAL SECURITY NUMBER: ____ /____/_____ Salutation: ___ Mr. ___ Mrs. ___ Ms. ___ Miss ___ Dr. NAME: ___________________________________________________________________________________________________________ Last First Middle Maiden or Former Names: ________________________ E-mail: _________________________________ Home Phone_________________Work Phone__________________Emergency Phone_______________ YOUR CURRENT ADDRESS: _____________________________________________________________________________________________________________________ Number & Street/P.O. Box City, State zip Code Country

YOUR PERMANENT ADDRESS: (If different from Current Address)

_________________________________________________________________________ Number & Street/P.O. Box

City, State zip Code

Country

BILLING ADDRESS: (If different from Current Address) ______________________________________________________________________________________________________________________ Number & Street/P.O. Box City, State zip Code Country

NEAREST OF KIN____________________ RELATIONSHIP:____________ PHONE:_________________ TERM OF EXPECTED ENTRANCE: ___ Spring Session 20 ___ ___Summer Session I 20___ ___ Summer Session II 20___ ___Fall Session 20___ I am voluntarily providing on this form my social security number with the understanding that it will be used only as a personal identifier for the internal recordkeeping and data processing operations of this institution.

SIGNATURE: __________________________

APPLICATION DATE: _____________________

GENDER: ____ Female ___ Male DATE OF BIRTH: ___/___/______ MARITAL STATUS: ___ Single ____ Married ___ Other RACE/ETHNIC GROUP: (Check one please) ___ White (not of Hispanic Origin) ___ Black (not of Hispanic Origin) ___ American Indian/Alaskan ___ Asian or Pacific Islanders ___ Hispanic (regardless of race) ___ Other CITIZENSHIP:

___ U.S. Citizen ___ Resident Alien (Green Card Holder) ___ Non-Resident Alien If not U S Citizen. indicate Country of Citizenship: ______________________________

LEGAL RESIDENCE: Do you claim to be a legal resident of the state of North Carolina for tuition purposes? ___ Yes = RM (Resident) ___ No = NM (Non-Resident). If "Yes" is checked, you must complete "Application Relating to Claimed North Carolina Residence for Tuition Purposes." If you claim to be a legal resident of the state of North Carolina, please circle the county of legal residence.

001 Alamance

026 Cumberland

051 Johnston

076 Randolph

002 Alexander

027 Currituck

052 Jones

077 Richmond

003 Alleghany

028 Dare

053 Lee

078 Robeson

004 Anson

029 Davidson

054 Lenoir

079 Rockingham

005 Ashe

030 Davie

055 Lincoln

080 Rowan

006 Avery

031 Duplin

656 Macon

081 Rutherford

007 Beaufort

032 Durham

057 Madison

082 Sampson

008 Bertie

033 Edgecombe

058 Martin

083 Scotland

009 Bladen

034 Forsyth

059 McDowell

084 Stanly

010 Brunswick

035 Franklin

060 Mecklenburg

085 Stokes

011 Buncombe

036 Gaston

061 Mitchell

086 Surry

612 Burke

037 Gates

062 Montgomery

087 Swain

013 Cabarrus

038 Graham

063 Moore

088 Transylvania

014 Caldwell

039 Granville

064 Nash

089 Tyrrell

015 Camden

040 Greene

065 New Hanover

090 Union

016 Carteret

041 Guilford

066 Northampton

091 Vance

017 Caswell

042 Halifax

067 Onslow

092 Wake

018 Catawba

043 Harnett

068 Orange

093 Warren

019 Chatham

044 Haywood

069 Pamlico

094 Washington

020 Cherokee

045 Henderson

070 Pasquotank

095 Watauga

021 Chowan

046 Hertford

071 Pender

096 Wayne

022 Clay

047 Hoke

072 Perquimans

097 Wilkes

023 Cleveland

048 Hyde

073 Person

098 Wilson

024 Columbus 025 Craven

049 Iredell 050 Jackson

074 Pitt 075 Polk

099 Yadkin 100 Yancey

If North Carolina is not your home State, please give your home State or Country here: ____________________ MILITARY STATUS: ___ Veteran (1) ___ Non-Veteran (2) Are you applying for Military Benefits? ___ Yes ___ No

___ In Service (3)

LIST ALL SCHOOLS OR COLLEGES YOU HAVE ATTENDED SINCE HIGH SCHOOL GRADUATION LIST THE MOST RECENTLY ATTENDED FIRST Name of School

Address (City, State)

Date Started

Date Exited

Degree Sought

Course or Major

Degree Earned (Yes or No)

Date Degree Awarded

1. Have you ever attended any other library or information science school? ___ Yes ___ No If yes, give name and dates of attendance. ____________________________________________________ 2. Reason for discontinuing: ________________________________________________________________ 3. Are you in good standing to return? ___ Yes ___ No How many quarter, semester or trimester hours of credits will you have toward advanced standing? ____ 4. Have you ever been a student at NCCU? ___ Yes ___ No If Yes, Date Last Attended: Month ___ Year ___ 5. All applicants must have taken the Graduate Record Examination, the Graduate Management Admission Test (joint MBA/MIS applicants only), or the Law School Admission Test (joint JD/MLS applicants only) within the past five years. Official reports of scores must be sent to us by Educational Testing Service. Our institution number is 5495.

Test

Date

a. Graduate Record Examination, Verbal Aptitude: b. Graduate Record Examination, Quantitative Aptitude c. Graduate Record Examination, Analytical Aptitude d. Test of English as a Foreign Language (TOEFL) – International students only e. Graduate Management Admission Test (GMAT) – Joint MBA/MIS students only f. Law School Admission Test (LSAT) – Joint JD/MLS students only

My scores: (check one) ___ will be sent ___ have been sent (give date): _________ ___ Two copies of unofficial scores are enclosed. 6. What foreign language or languages can you read? __________ Number of foreign language hours: ______

Score

%

7. Have you taken any computer programming language? ___ Yes ___ No. If yes, describe: _______________ 8. Have you taken any statistics course? ___ Yes ___ No. If yes, describe: ____________________________ 9. Cumulative grade point average in college: _________ Grade point average last 60 hours: ____________ Graduate school grade point average: _____________ Other: _________________________________

WORK EXPERIENCE List all jobs you have held (Include all civilian and military experience) Place

Nature of Work

Dates

Recommendations Give the names, address and phone numbers of two persons to whom recommendations were sent Name and Title

Street Address, City, State, Zip Code

Phone

ON A SEPARATE SHEET OF PAPER, BRIEFLY EXPLAIN WHY YOU WISH TO OBTAIN A MASTER'S DEGREE IN LIBRARY OR INFORMATION SCIENCE.

Notice: Falsifying or withholding information in completing this application violates the policies of the NCCU SLIS. This constitutes grounds for immediate withdrawal of your application from further consideration, or cancellation of your admission or registration I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. SIGNATURE: _________________________________ DATE: ___________________________

School of Library and Information Sciences North Carolina Central University Campus Safety Questions Student Name: _________________________

Social Security Number: _________________

You must answer all questions. Your “yes” answers to one or more of the following questions will not necessarily preclude your being admitted. However, your failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw your admission, or to dismiss you after enrollment. For the purpose of the following six questions, “crime” or “criminal charge” refers to any crime other than a traffic-related misdemeanor or an infraction. 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 of judgment continued, to a criminal charge? Yes No 3. Have you otherwise accepted responsibility for the commission of a crime? Yes No Yes No 4. Do you have any criminal charges pending against you? 5. 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 6. If you have ever served in the military, did you receive any type of discharge other than an honorable discharge? Yes No Currently serving Never served If you answered “yes” to any of the six questions above, please explain the circumstances (if you need additional space, attach a separate sheet and include your name, social security number, and sign and date the sheet.

I affirm that all information supplied is complete and accurate. Any misrepresentation of facts could be cause for denial of admission, cancellation of admission, or suspension from North Carolina Central University.

Signature: _________________________________________

Date: ________________

Prior to the deadline for the academic semester in which entrance to the School is proposed (July 1 for Fall admission and December 1 for Spring admission), send the following materials to: School of Library and Information Sciences North Carolina Central University P.O. Box 19586 Durham, North Carolina 27707 ___ Completed application form. ___ Letter of Intent, explaining why you wish to obtain the MIS or MLS degree. ___ The $40 application fee. Check or Money Order should be payable to North Carolina Central University. ___ Residency Form if claiming State of North Carolina Residency for tuition purposes. ___ Two official copies of transcripts for all post-secondary work. (Only one copy is required for NCCU transcripts). ___ Two official copies of standardized test scores. ___ International Financial Certificate (To be completed by all international applicants only). ___ Ask two persons to send us letters and/or reference forms attesting to your personal and academic qualifications for graduate study. For further information, contact NCCU SLIS at: Phone: 919-530-6485 Fax: 919-530-6402