APPLICATION FOR ADMISSION MASTER OF ARTS DEGREE IN ISLAMIC STUDIES. Name: Last Name First Name Middle Initial. Address: Number and Street Apt #
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1 APPLICATION FOR ADMISSION MASTER OF ARTS DEGREE IN ISLAMIC STUDIES Starting Session (check one): Status (check one): Fall Term Spring Term Summer Term (year) (year) (year) Full-time Part-time Applicant Information Name: Last Name First Name Middle Initial Address: Phone number: Address: Gender: Female Male Birth date: Birth Place: Citizenship: U.S. Permanent Non-Resident: Country of Citizenship Type of Visa If you are a foreign student, have you taken the TOEFL exam? Yes No Score Which language/s (if any) other than English do you regularly speak at home? Demographics Optional: The demographics section of this application is optional. Information provided will be used for College demographical statistics only and will NOT be used for admissions purposes. How do you identify yourself (Check all that apply): Hispanic Black or African American Middle Eastern South Asian (Indo-Pakistani etc.) East Asian (Chinese, Japanese etc.) White American Indian or Alaskan Native Other Marital Status: Never married Married Widowed Separated Divorced Religious preference: AIC 4/14
2 2 Educational Background College and University Education 1 Name of School attended: Address: Phone number: Entry Date: Website: Graduation Date: Academic Achievement: In addition to completing this section, please have your institution send your official transcripts to: Office of the Dean of Students, American Islamic College, 640 W. Irving Park Rd., Chicago, IL GPA: Scale: GRE Scores: MAT Scores: College and University Education 2 (if applicable) Name of School attended: Address: Phone number: Entry Date: Website: Graduation Date: Academic Achievement: In addition to completing this section, please have your institution send your official transcripts to: Office of the Dean of Students, American Islamic College, 640 W. Irving Park Rd., Chicago, IL GPA: Scale: GRE Scores: MAT Scores: Co-curricular Activities Please list your work experience here with (1) as the most recent experience. Please complete this section even if you plan to send your resume. Nature of Work 1: Employer: Dates: Nature of Work 2:
3 3 Employer: Dates: Current Extra-Curricular, Volunteer Activities, etc.: Extra-Curricular and Volunteer Activities in College (if any): Institution Name 1 City/State or Country (if outside the US) College-Level at Time: Freshmen Sophomore Junior Senior Graduate Student Hours Per Week: Weeks Per Year: Position: Paid Unpaid Participated During: School Year Summer/School Break Brief Description: Institution Name 2 City/State or Country (if outside the US) College-Level at Time: Freshmen Sophomore Junior Senior Graduate Student Hours Per Week: Weeks Per Year: Position: Paid Unpaid Participated During: School Year Summer/School Break Brief Description: Letters of Recommendation: Please identify two persons who will be submitting letters of recommendation on your behalf and who can vouch for your preparedness and motivation to complete graduate study. 1. Name (Please Print) Title Institutional Affiliation and/or Telephone Contact 2. Name (Please Print) Title Institutional Affiliation and/or Telephone Contact
4 4 Financial Assistance/Scholarship Would you like to be considered for Financial Assistance? Yes If yes, I would need assistance with: Tuition only No Room only Both Tuition & Room Are you interested in applying for the AIC Scholarship program? Yes No Are you interested in applying for the AIC Work/Study program? Yes No Writing Sample: Please submit either: (a) a writing sample (5+ typed pages) based on one of your previous classes or (b) an essay of no less than 1000 words, describing your interest and previous background in Islamic studies. Additional information: Please provide any additional information you would like to share regarding special circumstances, additional qualifications, etc., in the space provided below. If you need additional space, please use another sheet of paper and simply attach it to the application.
5 5 Have you ever been found responsible for a disciplinary violation at any educational institution you have attended, whether related to academic misconduct or behavioral misconduct that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution? Yes No Have you ever been adjudicated guilty or convicted or any misdemeanor, felony, or other crime or offense? Yes No Note that you are not required to answer yes to this question, or provide explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential. Have you ever been placed on academic or disciplinary probation by any educational institution? Yes No If you answered yes to the above question, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reflects on what you learned from the experience. Please also provide case information. Signature I certify that all information submitted in the admission process (including the application, the personal essay, any supplements, and any other supporting materials) is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be found or determined to be false. Signature Date: mm/dd/yyyy AIC does not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex, age, marital status, parental status, physical disability, learning disability, political affiliation, veteran status, or sexual orientation. American Islamic College, 640 W. Irving Park Rd., Chicago, IL Tel: Fax:
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