University of San Diego / John Tracy Clinic Application Instructions Master s & Credential Program: Deaf & Hard of Hearing Submit all documentation in a 9 x 12 inch envelope (approximate size). All admission materials submitted are not returnable and funds are non-refundable. Keep a copy of each document for yourself, since the JTC/USD Program does not make copies for students. Mary McGinnis Director, JTC/USD DHH Graduate Program John Tracy Clinic 806 West Adams Blvd. Los Angeles, CA 90007 Application Checklist Important: Check each item off when completed, and submit checklist with you application All Students Must Submit the Following: USD/JTC Admission Application Form Applicants must sign the Statement of Purpose page. Applications without a signature will be returned, and admission will be delayed. JTC Application Worksheet College/University Transcripts Applicants must submit three official, sealed transcripts from each and every college/university you ever attended, even if you only took one course. Keep one official transcript for yourself. Standardized Tests Three official copies of each test report. Letters of Recommendation Three letters of recommendation from academic professionals (professors) are required of all applicants. Send one sealed original of each. Resume Biography JTC Time Management Worksheet JTC Financial Budget Worksheet Application Fee $45 check payable to University of San Diego. In Addition, All International Students Must Submit the Following: English Language Requirements If your first language was not English, these tests may be required: The Test of English as a Foreign Language (TOEFL) and the Test of Written English (TWE). Note: The TWE is the required essay component of the computerbased TOEFL. Financial Documentation Certification of Finances and the Declaration of Finances Forms. Transcripts All applicants are required to submit official records from each academic institution attended after secondary school. Transcripts issued directly in English by the academic institution are preferred. Otherwise, all transcripts that are not issued in English must be accompanied by a certified English translation from an approved agency. Transcript Evaluation Report International applicants are required to have their transcripts evaluated by an independent credentials evaluation service.
GRADUATE SCHOOL ADMISSION APPLICATION PLEASE READ INSTRUCTIONS CAREFULLY. TYPE OR PRINT LEGIBLY. Personal Information LAST NAME FIRST NAME MIDDLE INITIAL ADDITIONAL LAST NAME(S) THAT MAY APPEAR ON TRANSCRIPTS Current Mailing Address Valid until / / Month / Day / Year STREET TELEPHONE ( ) TTY/Voice CITY, STATE WORK PHONE ( ) TTY/Voice ZIP or COUNTRY FAX ( ) E-MAIL SOCIAL SECURITY Permanent Address Active as of / / BIRTHDATE / / MALE FEMALE Month / Day / Year Month / Day / Year STREET BIRTHPLACE CITY, STATE LANGUAGE SPOKEN IN THE HOME ZIP or COUNTRY COUNTRY OF CITIZENSHIP COUNTRY OF PERMANENT RESIDENCE USD Plans I am applying for entrance in SUMMER (20 ) Distance Learning Program Onsite Program Program Choice Choose either the master s program only, or both the master s and the credential program: PROGRAM M.Ed. Special Education: Deaf & Hard of Hearing CODE NO. 225-34 CREDENTIAL Education Specialist: Deaf and Hard of Hearing CODE NO 225-34 I previously applied to USD for graduate admission in FALL (YR) SPRING (YR) SUMMER (YR) I attended from / / Program Degree I am applying for readmission to the same program YES NO N/A International Applicants and Permanent Residents International Applicant CURRENT VISA STATUS I REQUIRE A STUDENT VISA (F-1) I REQUIRE AN EXCHANGE VISITOR VISA (J-1) OTHER Permanent Resident International Permanent Address STREET CITY STATE/PROVINCE COUNTRY POSTAL CODE ALIEN REGISTRATION NUMBER I AM A PERMANENT RESIDENT (NON-U.S. CITIZEN, NON-VISA) HOW LONG HAVE YOU BEEN IN THE UNITED STATES?
Recommenders Please give the full name, address, and position of your three recommenders, who must be college/university professors who can attest to your ability to do graduate-level work. 1. NAME POSITION/ TITLE INSTITUTE/ORGANIZATION ADDRESS 2. NAME POSITION/ TITLE INSTITUTE/ORGANIZATION ADDRESS 3. NAME POSITION/ TITLE INSTITUTE/ORGANIZATION ADDRESS ACADEMIC INFORMATION Test Data List all dates on which you have taken or have scheduled to take the following exams: I have taken I will take Graduate Record Examinations (GRE) Mo/Year Mo/Year I have taken I will take California Basic Educational Skills Test (CBEST) Mo/Year Mo/Year I have taken I will take California Subject Examinations for teachers (CSET) Mo/Year Mo/Year I have taken I will take Reading Instruction Competence Assessment (RICA) Mo/Year Mo/Year I have taken I will take The Test for English as a Foreign Language (TOEFL)* Mo/Year Mo/Year *TOEFL required if native language is not English College/University Information List in chronological order ANY AND ALL colleges/universities that you have attended, or from which you hold a degree, or where you have taken any undergraduate courses, or where you have taken any graduate courses (including extension courses); and any 2-year community college or university at which you have attempted any course work. All transcripts must be on file before your application will be processed. Completion of the admission file is the responsibility of the applicant. 1. NAME OF INSTITUTION STATE OR COUNTRY 2. NAME OF INSTITUTION STATE OR COUNTRY 3. NAME OF INSTITUTION STATE OR COUNTRY 4. NAME OF INSTITUTION STATE OR COUNTRY 5. NAME OF INSTITUTION STATE OR COUNTRY 6. NAME OF INSTITUTION STATE OR COUNTRY Have you ever been placed on academic probation or academic dismissal by any college or university? Yes No If yes, please explain: Have you earned a bachelor s degree? Yes No Estimated GPA Bachelor s degree graduation date Have you completed any post-baccalaureate degrees (MA, etc.), credentials, or certificates? Yes No If yes, please list:
STATEMENT OF PURPOSE Please note that if you plan to submit the statement of purpose on a separate sheet, you must include the disclosure statement below along with your signature and date. Please write a brief narrative describing yourself, your career goals, and the importance of graduate study at this point in your life. You may discuss influences on your intellectual development, educational and cultural opportunities (or lack of them) which have been available to you, and the ways in which these experiences have affected you. This should not be a recording of facts already listed on the application; it should give the Admissions Committee a better sense of who you are and why you are applying to graduate school at the University of San Diego/John Tracy Clinic. If you are now in a graduate program at another university, please explain why you wish to leave. (Guideline: 500 words or less). You may write the statement on a separate piece of paper and submit it with your application. I certify that the information on this application is true to the best of my knowledge. I have read all the instructions and I understand that refusal of admission or cancellation of registration will result from misrepresentation in any portion of this application form. I further understand that any submitted records and documents are non-returnable and may not be photocopied for me or a third party. SIGNATURE DATE
ADDITIONAL INFORMATION Employment Record Please list any full-time positions you have held. Start with your present position. You are welcome to attach a resume describing the nature, scope and areas of responsibility of all work experience in lieu of completing this section. 1. POSITION COMPANY 2. POSITION COMPANY 3. POSITION COMPANY 4. POSITION COMPANY Please list any part-time or summer jobs you have held. 1. POSITION COMPANY 2. POSITION COMPANY Military Record BRANCH DATES / to / RANK AT ENTRY RANK AT SEPARATION IF NOT SEPARATED, CURRENT RANK MILITARY AWARDS OR HONORS Professional or Community Involvement List professional or community activities and any honors or awards earned. Use an extra sheet of paper if necessary. 1. ORGANIZATION OR ACTIVITY DATES / to / HOURS PER WEEK OFFICES HELD, SPECIAL RECOGNITION, AWARDS 2. ORGANIZATION OR ACTIVITY DATES / to / HOURS PER WEEK OFFICES HELD, SPECIAL RECOGNITION, AWARDS Hobbies or Special Interests
OPTIONAL STATISTICAL INFORMATION This information will not be used in, or in any way affect, the admission decision. After a decision is made, however, certain facts may prove helpful in identifying candidates for specific privately-endowed scholarships, in reporting institutional statistics to the U.S. Office of Education, and in recognizing the needs in University planning. Your voluntary provision of this data is most appreciated. Ethnic Background (U.S. Citizen/Permanent Residents only) American Indian or Alaska Native African-American/Black Asian American Native Hawaiian or Other Pacific Islander Puerto Rican Mexican American Cuban American Other Hispanic or Latino White/Caucasian Religious Preference Catholic Protestant Hindu Islamic Jewish LDS Other Hearing Status Deaf Hard Of Hearing Hearing Relatives Who Have Attended or Worked at The University of San Diego 1. NAME RELATIONSHIP 2. NAME RELATIONSHIP 3. NAME RELATIONSHIP 4. NAME RELATIONSHIP Application Influence Check the people, publications, or events that most influenced you to apply to USD/ JTC. JTC Website JTC Faculty JTC Guest Lecture in Course USD Publication JTC Graduate Student JTC Publication USD Website USD Event JTC Alum Visit to JTC USD Alum Friend/Relative JTC Parent JTC Event USD Faculty College Guide Who or what led you to apply to USD/JTC? Please list the other graduate schools to which you are applying. POLICY OF NON-DISCRIMINATION Neither the University of San Diego, nor the John Tracy Clinic discriminate on the basis of race, color, religion, sex, national origin, age, disability, or sexual orientation in the admission status of students. Inquiries concerning the implementation of the University's policies may be addressed to: USD Provost, 5889 Alcala Park, San Diego, CA 92110, (619) 260-4553. Inquiries concerning the implementation of the John Tracy Clinic's policies may be addressed to: President, John Tracy Clinic, 806 West Adams Blvd, Los Angeles, CA, 90007, (213) 748-5481.
EXAMINATIONS REQUIRED FOR ADMISSION University of San Diego/John Tracy Clinic Master's and Credential Program: Deaf and Hard of Hearing If you have test results in their original, sealed envelopes, they should be sent with the rest of your admission materials in the admission packet to Mary McGinnis at John Tracy Clinic. If you will be taking a test after you send in your application, please enter the USD Code 4849 on the test results request and submit the scores directly to the University of San Diego. Be sure, however, to also send at least two copies to your home, and don't open them, so they remain official copies, one of which you will send to Mary McGinnis at the John Tracy Clinic. CSET: Writing Skills is part of a new option to meet the California state basic skills requirement: 1. Candidates who pass all three subtests of CSET: Multiple Subjects AND the new CSET: Writing Skills test will be considered proficient in the skills of reading, writing, and mathematics and will not be required to take the CBEST. 2. Candidates who have already passed the California Basic Educational Skills Test (CBEST) DO NOT need to take the CSET: Writing Skills test. 3. Candidates are not required to take the CBEST, CSET, or RICA, unless they are seeking a California credential. If candidates student teach in the Onsite Program, the CBEST and CSET are required to be completed before elementary student teaching. Test Website Required Subtests Cost www.gre.com Verbal Reasoning Quantitative Reasoning GRE Graduate Record Exam CBEST California Basic Educational Skills Test CSET California Subject Examinations for Teachers RICA Reading Instruction Competence Assessment $170 ($70 if eligible for fee reduction) www.cbest.nesinc.com $41 www.cset.nesinc.com www.rica.nesinc.com Multiple Subjects Subtests: I Reading, Language, Literature, History, Social Science II Science, Math III PE, Human Development, Visual & Performing Arts Written Exam only Not Video Performance $70 per subtest ($210 total) $35 for Writing Skills, if used in place of CBEST $130 Total for All Tests $445-$551