Graduate Application

Graduate Form

"*" indicates required fields

1Citizenship

2Admissions

3General

4Education

5Employment

6Agreement

Citizenship

Check which one applies*

I am a citizen or permanent resident of the United States

I am not a citizen or permanent resident of the United States

Hidden

Please verify

I am an international student

Please apply through the international application at https://www.faulkner.edu/international-application/

Admissions
Location*
Degree Type*
Masters Program*
Emphasis/Track/Concentration (Master of Science in Management)*
Degree Type*
Degree Type*
Masters Program*
Ph.D. Program*
Doctor Program*
Masters Program*
Emphasis/Track/Concentration (Master of Arts in Humanities)*
Emphasis/Track/Concentration (Ph.D. in Humanities)*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*
Term*

General
Name*
First Middle Last
*If you are an international student, please put your surname/family name in the "Last" name field.
Maiden Name

Given Name

Preferred Name

Date of Birth*
Gender*
Social Security Number*

Address*
Street Address Address Line 2 City State ZIP Code

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Cell Phone*
Email*
Enter Email Confirm Email

Emergency Contact Name

Emergency Contact Phone Number
Emergency Contact Phone Number
Emergency Contact Phone Number - Alternate
Alternate Emergency Contact Phone Number
Emergency Contact Phone Number - Alternate
Alternate Emergency Contact Phone Number
Citizenship*
Ethnicity*
Race*
Country of Origin*
Country of Citizenship*
Please attach a photochopy of your passport or person ID*
Accepted file types: jpg, png, jpeg, pdf, doc, docx, Max. file size: 64 MB.
Must be 2MB or smaller. Accepts jpg, jpeg, png, pdf, doc, or docx file extensions.
Religious Preference*
Church Name

Do you plan to apply for financial aid?*

Yes

No
Are you using VA benefits?*

Yes

No
Are you a veteran?*

Yes

No
Have you ever been placed on probation, suspended or dismissed from any educational institution (high school, college, professional school, or law school, etc.) for ANY reason (including academic grounds or behavioral or disciplinary grounds, etc.)?*

Yes

No
If you answered "yes" above, please explain in detail the circumstances.*
Have you ever been arrested for any reason?*

Yes

No
If you answered "yes," please explain in detail the circumstances, including all charges and their ultimate disposition.*

Education
If you have attended school under another name (i.e. maiden name), please list below.

What is your language or mother tongue?*

How many previous colleges?*
1.) Name of College*

1.) College Location*
City State / Province / Region Country

1.) Did you graduate from this college/ will graduate?*

Yes

No
1.) Were your classes quarters or semesters?*

Quarters

Semesters
1.) Overall GPA*

Please input your GPA within the range of 0.0 - 4.0
1.) Month/Year Graduated or Expected Graduation*

1.) What was your Degree Type, Major, and Emphasis*

2.) Name of College*

2.) College Location*
City State / Province / Region Country

2.) Did you graduate from this college?*

Yes

No
2.) Were your classes quarters or semesters?*

Quarters

Semesters
2.) Overall GPA*

Please input your GPA within the range of 0.0 - 4.0
2.) Month/Year Graduated*

2.) What was your Degree Type, Major, and Emphasis*

3.) Name of College*

3.) College Location*
City State / Province / Region Country

3.) Did you graduate from this college/ will graduate?*

Yes

No
3.) Were your classes quarters or semesters?*

Quarters

Semesters
3.) Overall GPA*

Please input your GPA within the range of 0.0 - 4.0
3.) Month/Year Graduated or Expected Graduation*

3.) What was your Degree Type, Major, and Emphasis*

4.) Name of College*

4.) College Location*
City State / Province / Region Country

4.) Did you graduate from this college/ will graduate?*

Yes

No
4.) Were your classes quarters or semesters?*

Quarters

Semesters
4.) Overall GPA*

Please input your GPA within the range of 0.0 - 4.0
4.) Month/Year Graduated or Expected Graduation*

4.) What was your Degree Type, Major, and Emphasis*

5.) Name of College*

5.) College Location*
City State / Province / Region Country

5.) Did you graduate from this college/ will graduate?*

Yes

No
5.) Were your classes quarters or semesters?*

Quarters

Semesters
5.) Overall GPA*

Please input your GPA within the range of 0.0 - 4.0
5.) Month/Year Graduated or Expected Graduation*

5.) What was your Degree Type, Major, and Emphasis*

Does your academic record accurately reflect your capabilities?*

Yes

No
Describe why not*
Is your undergraduate degree in communication disorders, speech and hearing science, or speech language pathology?*

Yes

No
List the pre-requisite leveling courses you have taken.*
(Include Course Name/Number, Institution Name, Semester, and Grade per line.)
List any academic honors, awards, or achievements you have received.
List any scholarships you have been awarded.
Please list community service activities you have been involved in during the past 5 years including the organization name, your role/responsibilities, dates position was held, and include a brief description of activities you performed in your role.*
(Role, Dates of Participation, Organization Name, Description per line)
Please list any leadership activities that you have been involved in over the past 5 years including the organization name, your role/responsibilities, dates position was held, and include a brief description of activities you performed in your role.*
(Role, Dates of Participation, Organization Name, Description per line)
List any scholarly activities in which you have participated (conferences attended, research projects, etc.)
(Activity, Location, and Date per line.)
List any achievements, awards, and observation hours
(Activity, Location and Date per line.)
List any extracurricular activities you were involved in during your undergraduate program.
(Activity, Name of Institution, and Date from-to per line.)
List any volunteer opportunities you had that are related to speech language pathology.
(Activity, Location, and Date per line.)
List any employment experiences you had related to direct patient care.
Please include medical school.
(Activity, Location, and Date per line.)
Do you have documentation of your completed 25 observation hours signed by a certified SLP? (If admitted, documentation must be submitted to the Clinic Director by June 1)*

Yes

No
How do you plan to complete the 25 observation hours by the June 1 deadline?*
Do you have documentation of observation hours signed by a certified PA?*

Yes

No
Have you graduated from a PTA program?*

Yes

No
Are you licensed?*

Yes

No
What is your license number?*

Have you attended another PT program?*

Yes

No
If yes, where?*

E.g., university, institution, etc.
(US Students) State*
Have you taken the TOEFL or IELTS?*
I have taken the TOEFL
I have taken the IELTS
No
If you have not taken either the TOEFL or IELTS, when are you going to take the test?

mm/yyyy formatting. I.e., for September, 2021, you would input 09/2021.
TOEFL Score*

IELTS Score*

Are you eligible to return to this PT program?*

Yes

No
Have you taken the GRE?*

Yes

No
Are you a licensed or certified healthcare practitioner?*

Yes

No
What Certifications/Licenses do you hold? And in what state(s)?
How many attempts for the GRE?

Date last GRE was taken*

GRE Total Score*

Please fill out the highest score you received in each area below.
Verbal*

Quantitative*

Analytical Writing*

Have you requested the score be sent to Faulkner University? (Institution Code – 1034)*

Yes

No
Have you taken the MAT?*

Yes

No
Date MAT was taken*

MAT Score*

Have you taken the GMAT?*

Yes

No
Date GMAT was taken*

GMAT Score*

Employment
Are you currently employed?

Yes

No
Is your company reimbursing you for your tuition?

Yes

No

Unsure
Employer Name

Department

Position

Work Number

Work Location
City State / Province / Region Country

Agreement
What was the most significant factor influencing your decision to apply to Faulkner?*
How did you first hear about the Ph.D. in Health Sciences program at Faulkner University?*
Faulkner University is a Christian university and as such has definite expectations about the conduct and character of those it admits as these matters have a definite impact on the spiritual and educational environment it is striving to create. Faulkner reserves the right to deny admission to or revoke the admission of anyone who has engaged in conduct that would, in its sole discretion, be detrimental to the educational and spiritual environment it is striving to maintain. Faulkner also reserves the right to deny admission to or revoke the admission of anyone who has engaged in conduct that would, in its sole discretion, lead the University to believe he or she would pose a risk of harm to persons on campus or would create safety concerns that would be detrimental to the campus environment.*
I accept the codes of conduct above
How did you first hear about the MA/MS SLP program?*
How did you first hear about Faulkner University’s MS-PAS program?*
Name of the person who referred you.

I understand that if I have misrepresented or failed to disclose any of the information requested on this application that the University reserves the right to deny my admission or to revoke my admission. I hereby certify that all information provided to Faulkner University is true, accurate, and complete. I agree that Faulkner University has my permission to verify all information relevant to my admission, including a criminal background check.*
I certify the above statements are true
I understand the requirements of the application must be submitted with this form in order for admission by the Faulkner University International Admission Committee.*
I understand
I understand that all documents, once submitted, become the sole property of Faulkner University and no documents will be returned to the applicant.*
I understand
I do, in so far, attest to the accuracy and validity of all information submitted herewith, and I understand that if I have misrepresented or failed to disclose any of the information requested on this application that the university reserves the right to deny my admission or revoke my submission.*
I attest to the validity of all information submitted
I understand that Faulkner University may communicate via email or by post in regards to my application and decision.*
I understand that I may be contacted via email or post by Faulkner University
Application Fee (Master of Arts/Science SLP)

Price:

Application Fee (OTD)*

Price:

Application Fee (Master of Arts SLP)*

Price:

Application Fee (Master of Science in PAS)*

Price:

Application Fee (DPT)*

Price:

Application Fee Total

Credit Card

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Visa
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Card Number
Expiration Date Month Year
Security Code Cardholder Name
Electronic Signature*
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Phone
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Form has been tagged under:Application, International Students

Introduction

Graduate Form

Citizenship

Admissions

General

Education

Employment

Agreement