Supplemental Questionnaire

 
Applicants for all programs must answer these questions.  Please include this sheet with the application materials that you submit to the Office of Graduate Studies of the College of Education.

Applicants for the graduate programs in Educational Leadership and Cultural Foundations must also provide:
(1)  Three Graduate Record Examination scores:  Verbal, Quantitative,
      and Analytic
(2)  Vitae
(3)  Three recommendations:  one to address academic potential; one
      to address leadership/administrative potential; and one additional
      from either category
(4)  Supplemental Questionnaire

  1. Your Full Legal Name:

  (Last)____________________(First)__________________(Middle)_______

  2. Current Mailing Address:

  (Street &    Number)____________________________________________

  (City)________________(State)_______(Zip)_______(Country)_________

  3. Permanent Mailing Address:

  (Street & Number)_____________________________________________

  (City)________________(State)_______(Zip)_______(Country)_________

  4. Home Phone Number:________________________________________   

  5.  Cell Phone Number: ________________________________________ 

  6. Business Phone Number:_____________________________________

  7. E-mail Address:____________________________________________

  8. Fax Number:_______________________________________________

  9. Current Employer & Position:____________________________________
      
   _______________________________________________________________

  10. Date:________________________________________________________

  11. Please indicate if you intend to enroll as a ______Full Time or
         ______Part Time student.
 

  12. Please indicate in the blank the degree for which you are applying:

              ______ Ph.D.     ______ Master's     ______ Ed.S. 

 
  13. Have you previously been enrolled in a program in ELCF at the
        West Lafayette campus of Purdue University?

          ______yes ______no

        If "yes," who was your academic advisor? 

         ______________________________________

        What year(s) were you in attendance? 
        
         _________________________________________

  14. Within the field of Educational Leadership and Cultural
        Foundations , identify the area of specialty or level
        that is of special interest:

       (Area and/ or level of special interest):

       _______________________________________________________

  15. Is there a faculty member in ELCF with whom you would like to
        work closely?
        _______________________________________________________

  16. Please address the following issues:

        a.   What are your present short-term and long-term goals and
             career objectives?

        b.   What previous experiences and/or personal qualities do you
              have which you believe will be helpful in meeting your goals
              and career objectives?

        c.   How will the graduate programs at Purdue University aid in 
              attaining your goals and career objectives? What are your
              expectations?