Division of Graduate Studies

Application for Graduate Second Chance

SECTION I: Personal Information

Date of Application

Full Name

Last, First Middle

e-mail address:

J Number: J Social Security Number

Telephone: Home/Cell Work

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SECTION II: Academic Information

Date of Last Enrollment at JSU:

Degree: Select 1 Doctor of Philosophy, Ph.D. Doctor of Education, Ed.D. Doctor of Public Health, Dr.P.H. Specialist in Education, Ed.S. Master of Arts Master of Arts in Teaching Master of Business Administration Master of Music Education Master of Professional Accountancy Master of Public Health Master of Public Policy and Administration Master of Science Master of Science in Education Master of Science in Teaching Master of Social Work

Major: select 1 Accounting Biology Business Administration Chemistry Clinical Psychology Communicative Disorders Computer Science Community Counseling Criminal Justice Early Childhood Education (Ed.S.) Educational Administration Elementary Education Engineering English Environmental Science Guidance Guidance-Psychometry Hazardous Materials Man. History Mass Communications Mathematics Music Physical Education Political Science Public Administration Public Health Public Policy and Administration Reading Rehabilitation Counseling School Counseling Science Education Secondary Education Social Work Sociology Special Education Sports Science Teaching Technology Education Urban Higher Education Urban and Regional Planning

Desired Enrollment Semester: Fall Spring Summer Year 20

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SECTION III: Please include an academic enhancement plan (AEP) with a signature from your advisor.
Failure to mee the academic requirements of the AEP will  result in a permanent dismissal.

I certify the information supplied is correct and complete.

Signature: ___________________________________ Date: _________________________

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SECTION IV: APPROVALS We have reviewed the requirements of the department/program.(Please sign and date). (Please attach a current "JSU Transcript".)

Major Advisor: _________________________________________ Type Name:	Approved Denied (list reason) Comments_______________________________________ ___________________________________________________
. Department Chair/ Program Director: _______________________________________ Type Name:	Approved Denied (list reason) Comments_______________________________________ ___________________________________________________
. Academic Dean: _______________________________________ Type Name:	Approved Denied (list reason) Comments_______________________________________ ___________________________________________________

For the Division of Graduate Studies

. . _________________________________________________ Name/Date

Approved Denied (list reason) Comments_______________________________________ ___________________________________________________

Processed by the Registrar _________________________

Name/Date

SECTION V: Academic Review: Courses to Transfer from Academic History to New Academic Program

Dept.	No	Title	Sem. Hrs.	Grade	Semester
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W
			0.50 1.00 2.00 3.00 4.00 5.00 6.00 9.00 12.00	A B C D F I IP W