DOCTORAL DEGREE PROGRAMS

DOCTORAL DEGREE PROGRAMS Application Fo Admission 5700 College Road, Lisle, Illinois 60532 Phone: (877) 353-9622 FAX: (630) 829-1375 Email: adultenollment@ben.edu Web Addess: ben.edu Fee Code ADM staff appoval 2016-2017 Date

APPLICATION INFORMATION Docto of Philosophy (Ph.D.) in Oganization Development (O.D.) A Full Application Packet fo this pogam includes: Completed application fo admission and $50 application fee (non-efundable) Caee objective essay - details below Cuent pofessional esume (including employment histoy with details of leadeship esponsibilities, skill sets and esults; school, community and othe leadeship positions; sevice activities; petinent publications, pesentations and involvement in pofessional oganizations) - details below Official tanscipts fom all univesities attended - details below Lettes of Recommendation - one pofessional and one academic - details below Intenational Student Infomation/Financial Suppot - if applicable - details below A pesonal inteview with a doctoate faculty membe may be scheduled afte eceipt of all documents. Lisle Campus pogam: Applications fo the Apil 2018 stat ae accepted beginning June 2017. Spingfield Campus pogam: Applications fo the Apil 2017 stat ae accepted beginning July 2016. Docto of Philosophy (Ph.D.)/Docto of Business Administation (D.B.A.) in Values-Diven Leadeship A Full Application Packet fo this pogam includes: Completed application fo admission and $50 application fee (non-efundable) Caee objective essay - details below Cuent pofessional esume (including employment histoy with details of leadeship esponsibilities, skill sets and esults; school, community and othe leadeship positions; sevice activities; petinent publications, pesentations and involvement in pofessional oganizations) - details below Official tanscipts fom all univesities attended - details below Lettes of Recommendation - one pofessional and one academic - details below Intenational Student Infomation/ Financial Suppot - if applicable - details below A pesonal inteview with a doctoate faculty membe may be scheduled afte eceipt of all documents. Applications fo the Mach 2017 stat ae accepted beginning Apil 1, 2016; Deadline is Novembe 1, 2016. Applications eceived afte Novembe 1, 2016 will be consideed on a space-available basis. ACADEMIC INFORMATION PLEASE CHOOSE THE PROGRAM FOR WHICH YOU ARE APPLYING Docto of Philosophy in Oganization Development Main Campus Spingfield Docto of Philosophy/Docto of Business Administation in Values-Diven Leadeship ADMISSIONS INFORMATION When do you expect to ente Benedictine Univesity? 2017 2018 On what campus do you plan to attend? Main Campus Spingfield (Ph.D. in Oganization Development only) How did you hea about Benedictine Univesity? Have you visited the Benedictine Univesity campus? No Yes ENTRANCE REQUIREMENTS Ph.D. in Oganization Development Maste s degee fom an accedited institution. Intenational Students: TOEFL and/o IELTS scoes may be equied (confim with depatment) Essay Statement - Email Sepaately: Please submit you esponse to the following, double-spaced, one-to-five pages in length: Descibe how the Ph.D. fits with you long-tem caee objectives. Please include potential aeas of eseach inteest and any intenational wok expeience. Ph.D./D.B.A. in Values-Diven Leadeship Maste s degee fom an accedited institution. Intenational Students: TOEFL and/o IELTS scoes may be equied (confim with depatment) Essay Statement - Email Sepaately: 1. Descibe you pesonal and pofessional goals and how a Ph.D./ D.B.A. will help you achieve you goals. 2. Descibe why you ae inteested in a degee in Values-Diven Leadeship. 3. Descibe potential topics of inteest fo you dissetation. 4. Doctoate pogams ae igoous but ewading. Please comment on pesonal attibutes as well as pevious expeiences that ae eflective of you ability to successfully complete a doctoate-level pogam. You ae encouaged to be ceative in you answe but hee ae some suggestions of infomation you may want to conside when cafting you esponse: Pevious academic and pofessional expeiences that document you capacity fo leaning Pesonal chaacteistics you will contibute to the pogam What makes you a good candidate fo this pogam

ENTRANCE REQUIREMENTS OFFICIAL TRANSCRIPTS 1. You school(s) may be appoved to send official tanscipts electonically to Benedictine Univesity. If so, please have them sent diectly to adultenollment@ben.edu and we will confim acceptance of official documents upon eceipt. 2. If submitting pape tanscipts, they must bea the signatue of the egista and institutional seal. Mail to: School of Gaduate, Adult and Pofessional Education Attn: Admissions Office 5700 College Rd. Lisle, IL 60532 3. Foeign cedit must be evaluated by Educational Pespectives at www.edpespective.og/benedictine o Education Cedential Evaluatos (ECE) at www.ece.og. ECE epots must be a couse by couse evaluation of tansfe cedit. An official evaluation must be sent diectly fom ECE to Benedictine Univesity. Please contact the School of Gaduate, Adult and Pofessional Education fo moe infomation. LETTERS OF REFERENCE All doctoate pogams equie two lettes of efeence. Fo the Ph.D./D.B.A. and Ph.D. in O.D. pogams, submit two lettes of ecommendation, one pofessional and one academic that speak to you chaacte, capacity, pefomance and ability to do doctoal level wok with excellence. Please list the name, elationship and position of efeences below and have each efeence send thei lette diectly to the pogam contact listed at end of document. NAME RELATIONSHIP POSITION NAME RELATIONSHIP POSITION The following infomation applies to all pogams: 1. All documents submitted become popety of Benedictine Univesity and will not be eleased to the student o any thid paty. 2. Students with a documented physical o mental disability may be eligible fo special accommodations though the Ameicans with Disabilities Act. Please contact the Academic and Caee Enichment Cente fo moe infomation. GENERAL INFORMATION LAST NAME FIRST MIDDLE MOBILE PHONE OFFICE PHONE HOME PHONE OTHER NAMES MAIDEN (IF ANY) SOCIAL SECURITY NUMBER HOME COUNTRY STREET ADDRESS EMAIL ADDRESS CITY STATE 9-DIGIT ZIP CODE RELIGION (OPTIONAL) COUNTY MARITAL STATUS MALE DATE OF BIRTH (MM/DD/YY) SINGLE MARRIED OTHER FEMALE Is English the pimay language spoken in the home? No Yes If no, please state language Ae you a U.S. citizen? No Yes If yes, check one: By bith By natualization (natualization cetificate numbe:) If no, ae you a U.S. pemanent esident/immigant/geen cad holde? No Yes If yes, please attach a copy of you pemanent esidency cad. Have you eve pleaded guilty o no contest to, o been convicted of, a felony? No Yes If yes, please povide date(s) and details ANSWERING YES DOES NOT CONSTITUTE AN AUTOMATIC BAR TO ADMISSION. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION AND REHABILITATION WILL BE TAKEN INTO ACCOUNT. NOTE: YOU ARE NOT OBLIGATED TO DISCLOSE THE EXISTENCE OF ANY CONVICTION OR ARREST RECORDS WHICH HAVE BEEN SEALED OR EXPUNGED PURSUANT TO CHAPTER 20, SECTION 2630/12 OF THE ILLINOIS COMPILED STATUTES.

EMPLOYER INFORMATION - RESUME REQUIRED Ae you cuently employed? No Yes Full Time Pat Time Ae you a vetean o cuently seving in the U.S. Militay? No Yes Ae you o have you eve been an employee of Benedictine Univesity? No Yes EMPLOYER/COMPANY NAME POSITION TELEPHONE WORK EMAIL (OPTIONAL) ADDRESS CITY, STATE, ZIP COUNTY COUNTRY DESCRIBE YOUR CURRENT JOB RESPONSIBILITIES Does you employe povide tuition eimbusement? No Yes Please submit you cuent pofessional esume to the depatment as an electonic attachment. EDUCATIONAL HISTORY IMPORTANT: FAILURE TO LIST BELOW ALL UNIVERSITIES AND POST-SECONDARY INSTITUTIONS IN WHICH YOU ENROLLED (INCLUDING CORRESPONDENCE AND EXTENSION COURSES) MAY RESULT IN DELAY IN ADMISSION, LOSS OF TRANSFER CREDIT, AND/OR DISMISSAL. IT IS THE APPLICANT S RESPONSIBILITY TO HAVE OFFICIAL TRANSCRIPTS FORWARDED FROM EACH INSTITUTION IN WHICH YOU ENROLLED. AN OFFICIAL TRANSCRIPT IS REQUIRED EVEN IF ENROLLMENT WAS FOR A BRIEF TIME AND NO CREDIT WAS ESTABLISHED. NAME(S) OF ALL COLLEGE(S) ENROLLED AND CITY/STATE DATES ENROLLED DEGREE CONFERRED MAJOR MINOR GPA (Undegaduate & Gaduate Level) (check box if last school attended) Fo students with intenational postgaduate level cedits,* indicate yeas of full-time study instead of cedit hous: One yea o less Two yeas Thee yeas Fou yeas o moe *Students with cedits eaned outside the United States may be equied to have these cedits evaluated. Will you have a postgaduate degee completed pio to enollment at Benedictine Univesity? No Yes If yes, what degee? I undestand that I must disclose all schools enolled and failue to do so can lead to the denial of admission, evoking of admission o administative withdawal fom couse enollment. Signatue Have you eve applied to any doctoate pogam at Benedictine Univesity? No Yes If yes, when? Have you eve enolled at Benedictine Univesity? No Yes If yes, dates enolled If yes, have you attempted any college cedit since attending Benedictine Univesity? No Yes Have you eve been suspended, placed on pobation o dismissed fom any high school o college? No Yes If yes, please explain the following on a sepaate sheet of pape: date of occuence, summay of incident, how you wee held accountable (outcomes, sanctions, etc.) and any additional infomation you wish to povide. Please note: additional infomation may be equested.

INTERNATIONAL STUDENT INFORMATION If you ae an intenational applicant fo a doctoal pogam planning to study unde a visa, please complete the following infomation showing equied citizenship and financial infomation. An intenational applicant is a citizen o pemanent esident alien of a county othe than that of United States. Any student who is a U.S. citizen o a U.S. pemanent esident with intenational cedit is consideed a domestic student and does not need to complete this page. County of citizenship: County of bith: City of bith: County of esidency: Ae you cuently in the U.S. on a visa? No Yes If yes to above, please indicate visa type: When does you cuent visa expie? Month: Day: Yea: Please indicate which school in the U.S. you ae attending: If you intend to tansfe you SEVIS ecod fom you cuent school, please email ips@ben.edu fo citical infomation. I equest Benedictine to issue the following: I-20 (fo F-1 student visa). My pimay souce of funding will be a Benedictine assistantship, pesonal funds o funds fom family o fiends. (F-1 dependents will be issued F-2 visas.) DS-2019 (fo J-1 Exchange Visito/Student visa). My pimay souce of funding will be U.S. o home-county govenment o an intenational oganization. (J-1 dependents will be issued J-2 visas.) I do not need Benedictine documents because my sponsoing agency will issue (e.g. Fulbight). I will emain on visa (attach photocopies of you visa and I-94). Upon admission, please send copies of the following documents: You cuent visa All I-20s and/o DS-2019s You cuent I-94* (font and back) I-94s, passpot photocopies and visas of all dependents *Electonic I-94s may be pinted fom https://i94.cbp.dhs.gov/i94/equest.html INTERNATIONAL STUDENT FINANCIAL SUPPORT FORM (fo F and J visa students only) Please complete all infomation equested in this section. I. Souce of Suppot I will pay fo school with my pesonal funds. I will be sponsoed by anothe individual, i.e. paents, family membe, othe sponso. I will be sponsoed by a govenment o oganization. Official documents in the fom of bank statements, cetified scholaships o awad lettes must be eceived and will not be etuned. II. Souce of Funds (Amounts in this section must match attached financial documents): Name of Account Holde: Name of Financial Institution: Addess of Institution: Name of Institution Official: Account Numbe: Sponsoing Oganization: Total Amount Available in USD: $ III. Student Declaation of Accuacy I cetify that the infomation given on this fom is complete and accuate to the best of my knowledge. I am fully awae that any false o misleading infomation will esult in disciplinay action and possible temination of my SEVIS ecod. Name Signatue Date

NON-DISCRIMINATION POLICY In administeing its affais, Benedictine Univesity does not disciminate against any peson on the basis of ace, ceed, colo, national o ethnic oigin, sex, age, disability, militay o vetean status, maital status, citizenship, o any othe chaacteistic potected by applicable law. The laws applicable to Benedictine Univesity include constitutional and statutoy potections of the Univesity s ights as a eligiously sponsoed institution. READ CAREFULLY AND SIGN AS INDICATED REQUIRED I AGREE TO COMPLY WITH THE REGULATIONS AND REQUIREMENTS OF BENEDICTINE UNIVERSITY, AND TO COOPERATE WITH THE ADMINISTRATIVE OFFI- CERS, FACULTY AND MY FELLOW STUDENTS IN MAINTAINING HIGH STANDARDS OF CONDUCT AND SCHOLARSHIP AND IN PROMOTING THE GENERAL WELFARE OF THE UNIVERSITY. I UNDERSTAND THAT THE UNIVERSITY RESERVES THE RIGHT TO CANCEL THE REGISTRATION OF ANY STUDENT AT ANY TIME WHATSOEVER FOR REASON OF DEFICIENCY IN SCHOLARSHIP, UNSATISFACTORY CONDUCT OR FOR ANY OTHER JUST CAUSE. I AGREE TO PAY ALL FEES IN ADVANCE EACH TERM OR BY SPECIAL ARRANGEMENT WITH THE UNIVERSITY. I CERTIFY THAT THE INFORMATION I HAVE PRO- VIDED IS TO THE BEST OF MY KNOWLEDGE CORRECT AND COMPLETE. FAILURE TO PRESENT ACCURATE INFORMATION IN THIS DOCUMENT CAN LEAD TO THE DENIAL OF ADMISSION, REVOKING OF ADMISSION OR ADMINISTRATIVE WITHDRAWAL FROM COURSE ENROLLMENT. I HEREBY AUTHORIZE BENEDICTINE TO INVESTIGATE ANY STATEMENT CONTAINED IN THIS APPLICATION. I HEREBY RELEASE ANY PARTY FROM LIABILITY AS A RESULT OF ANY INFORMATION PROVIDED TO BENEDICTINE. IT IS UNDERSTOOD THAT I ACCEPT REGISTRATION AS A STUDENT AT BENEDICTINE SUBJECT TO THE ABOVE PROVISIONS. I UNDERSTAND THAT I MAY BE PHOTOGRAPHED OR VIDEOTAPED WHILE AT BENEDICTINE UNIVERSITY. I GIVE PERMISSION FOR PHOTOS OR VIDEOTAPE OF ME TO BE USED TO PROMOTE BENEDICTINE UNIVERSITY AND THAT SUCH PHOTOS AND VIDEO WILL BE THE PROPERTY OF BENEDICTINE UNIVERSITY. I ALSO GIVE PERMISSION FOR INFORMATION ABOUT MY ACCOMPLISHMENTS WHILE A STUDENT AT BENEDICTINE UNIVERSITY TO BE USED TO PROMOTE BENEDICTINE UNIVERSITY. Signatue of Applicant Date Fo additional infomation o to submit additional mateials, please contact: Ph.D. in Oganization Development in Lisle Phyllis Meyes pmeyes@ben.edu (630) 829-6208 Ph.D. in Oganization Development in Spingfield Janet Richte jichte@ben.edu (217) 718-5276 Ph.D./D.B.A. in Values-Diven Leadeship Associate Diecto info@cvdl.og (630) 829-6225