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MSE Application

PERSONAL DATA
Full Name: 
Address:
City:
State: Zip:
County:
Home Phone:
Email Address:  
Date of Birth:
Gender:  
First term you plan to register for courses:


WORK/SCHOOL INFORMATION
Work/School Name:
School District:
Work/School Address:
City:
State: Zip:
Work/School Phone:
Grade Level Currently Teaching:
What certification do you currently hold? (Elementary, Secondary, other)
Are you currently employed in the teaching field?
Please list professional teaching experience including substitute teaching:
School/District:
City/State:
Date From:
Date To:
 
School/District:
City/State:
Date From:
Date To:
 
School/District:
City/State:
Date From:
Date To:
ACADEMIC PREPARATION

Please list the credits/degrees you have earned at the college level, including Lebanon Valley College

IMPORTANT: You must request an official transcript be sent from each of the colleges or universities to : MSE Program, Lebanon Valley College, Annville, PA 17003.
College/University:
City/State:
Dates Attended:
Credits:
Degrees:
 
College/University:
City/State:
Dates Attended:
Credits:
Degrees:
 
College/University:
City/State:
Dates Attended:
Credits:
Degrees:
Please list the individuals who you anticipate will be writing letters of recommendation for you.

UNDERSTANDING

By checking this box and submitting this on-line application, I hereby make application for admission and certify that all the information is complete and accurate to the best of my knowledge. I understand that all credentials submitted in support of this application become the property of the college and are not returnable. I have read all Lebanon Valley College policy statements relating to continuing education and agree to abide by them.

Additional Admission Requirements

All application materials must be received for an applicant to be considered for acceptance into the MSE program. Three letters of recommendation, a personal statement (1 page) stating why you wish to pursue the MSE program, and official transcripts from each of the colleges and universities you have attended must be sent along with a check for the $30.00 non-refundable application fee to:

MSE Program
Room 210 - Neidig Garber Science Center
North White Oak Street
Lebanon Valley College
Annville, PA 17003

Lebanon Valley College does not discriminate on the basis of race, national or ethnic origin, sex, age, religion, sexual preference or handicap.