Graduate Studies at Fitchburg State University
Graduate education at Fitchburg State University will help you achieve your academic and career goals at an
affordable cost and at locations convenient for you. The university offers on campus and online full- and part-time
graduate degree programs, professional certificate programs, and lifelong learning opportunities in the most
competitive professional and academic fields.
Fitchburg State’s graduate programs are well-respected throughout the region and our alumni enjoy successful
careers in a wide variety of professions. Our faculty are actively involved and accomplished in their respective fields
and are committed to your success.
MASTER’S DEGREES
• Master of Arts in Biology, English Studies, and History
• Master of Arts in Teaching in Biology, English Studies, and History
• Master of Business Administration
• Master of Education in Arts Education, Curriculum and Teaching, Early Childhood Education, Educational
Leadership and Management, Elementary Education, Middle School Education, Occupational Education,
Science Education, and Special Education
• Master of Science in Applied Communication, Computer Science, Counseling, and Forensic Nursing
ADVANCED PROFESSIONAL DEGREES
Certificates of Advanced Graduate Study (CAGS) are designed for those with an appropriate master’s degree
who wish to attain greater competency:
• Educational Leadership and Management • Interdisciplinary Studies
Graduate Level Certificate Programs are offered in a variety of professional concentrations and require
bachelor’s degrees—some require master’s degrees or other certification/licensure prerequisites:
• Applied Communication Studies • Forensic Nursing (Online only)
• Behavior Analyst (Online/Hybrid only) • Not-for-Profit Management
• Educational Technology • Reading Specialist (Online/Hybrid only)
• Fine Arts Director • Post Baccalaureate Certificate for Initial Teacher Licensure
Admission
Admission to Fitchburg State University is competitive and reflects a high standard of academic excellence.
In addition to having a bachelor’s degree from a regionally accredited four-year institution, you must also meet
the appropriate academic department criteria to be eligible for admissions consideration. Please refer to the
relevant program descriptions in the Fitchburg State University Graduate Catalog (available online at
www.fitchburgstate.edu/catalog).
To apply for admission to a graduate program, please submit all relevant items outlined in the Graduate Application
Checklist. Please refer to any symbols listed next to the graduate programs in Section V of the application to
determine if there are additional requirements for your specific program. Completed applications are reviewed
on a rolling admission basis by the appropriate departmental committee which makes its recommendation to the
Director of Admissions. You will be notified in writing of the final decision, on average two to four weeks after your
application becomes complete. Applicants who are accepted to a program after the add/drop period (traditionally,
two weeks after the start of the semester) will be offered admission for the subsequent semester.
GRADUATE
Application for Admission
International Applicants
In addition to the Graduate Application for Admission, international applicants must:
• Complete an International Application Supplement. You may download the supplement
at www.fitchburgstate.edu/admissions/undergraduate/international
or request one at [email protected].
• Complete their application by the following deadlines:
o Fall Semester: June 1
o Spring Semester: October 1
Applications received after the published deadline may be deferred a semester at the discretion of the
Admissions Office if it is determined that we would not have enough time to review the application, make
a decision, and process visa requests in a timely manner.
Students with Disabilities
Fitchburg State University is committed to making the academic experience for students with disabilities
a positive one. If you are accepted to Fitchburg State University and need specific accommodations, you
are required to submit written documentation from qualified professionals and/or evaluation sources to
verify eligibility under section 504 of the Rehabilitation Act of 1973 and/or the Americans with Disabilities
Act of 1990. Protection under this statute is based on documentation of a disability that substantially
limits a major life activity.
If you would like further information, please refer to the Disability Services website
at www.fitchburgstate.edu/disability or contact Disability Services directly—(978) 665-3427.
Graduate Application Checklist
S Graduate Application for Admission
S Non-refundable application fee: $40 for all applicants. Do not send cash. Please print applicant’s first and last name
on the check or money order payable to Fitchburg State University.
S Official transcript from your baccalaureate degree granting college/university. The transcript must indicate
degree received and date of graduation. Applicants to the CAGS programs—with the exception of the Interdisciplinary
Studies: Counseling/Psychology and Reading Specialist programs—must submit a transcript from the master’s degree
granting college/university.* For the Interdisciplinary Studies: Counseling/Psych0logy and the Reading Specialist programs,
transcripts from both the bachelor’s and master’s degree granting college/university are required.
S Official transcripts from all colleges/universities where you have taken graduate courses and/or received graduate
degrees. Applicants to a CAGS program must submit an official transcript from the master’s degree granting college/
university listing the degree received and date of graduation.
*
S Standardized Test Scores. Many master’s degree programs require the official results from one of the three following
tests: the Graduate Management Admissions Test (GMAT), the Graduate Record Examination (GRE), or the Miller’s
Analogies Test (MAT).
**
Please refer to the list below to determine the appropriate test. If tests are more than five years
old, new test results will be required.
• MBA program: GRE or GMAT is required
• MA or MAT in Biology, MEd in Science Education, and MS in Computer Science: GRE is required
• MA or MAT in English Studies or History, MEd in Arts Education, Occupational Education, and the
MS in Applied Communication, Counseling, and Forensic Nursing: GRE or MAT is required
• CAGS programs, or those seeking a second master’s degree, test scores are not required, EXCEPT for:
CAGS in IDIS Counseling/Psychology
***
and MS in Counseling programs: GRE or MAT is required.
The Fitchburg State University code for the GRE is 3518, for the GMAT it is 3518, and for the MAT it is 1208.
S Three letters of recommendation from individuals under whom the applicant has studied or under whose supervision
he/she has worked in a professional capacity. At least one letter of recommendation should speak to the applicant’s
academic abilities. Please use the Letter of Recommendation forms provided and ask the evaluator to submit the narrative
portion of the recommendation on professional letterhead. All letters of recommendation must be mailed by the evaluator
directly to the Admissions Office.
S A professional resume
S Additional requirements may be needed for your intended program. Please see Section V: Intended Degree list in this
application. Additional requirements will be notated by a symbol after the program title.
*
For the purposes of admission and transfer credit, only courses taken and degrees earned at regionally accredited institutions are recognized
by Fitchburg State University. International degrees will be reviewed for equivalent standing through the official evaluation process.
**
Standardized tests are not required for the MEd in Curriculum and Teaching, Early Childhood Education, Educational Leadership and Management,
Elementary Education, Middle School Education and Special Education.
***
Test results for this program may be up to 10 years old.
Application Mailing Address
The application and all supporting documents should be sent to:
Admissions Office, Fitchburg State University — 160 Pearl Street, Fitchburg, MA 01420
ALL TRANSCRIPTS MUST BE OFFICIAL AND IN SEALED ENVELOPES,
SENT DIRECTLY FROM THE COLLEGE/UNIVERSITY TO THE ADMISSIONS OFFICE
Additional Requirements (Please refer to Section V of the Application)
l Personal statement
MEd Arts Education, MS Counseling, MS Forensic Nursing and Graduate Certificate Forensic Nursing:
Please describe your goals and reasons for applying to your chosen program (maximum 300 words.)
MS Forensic Nursing and Graduate Certificate Forensic Nursing: In addition to the above, please submit a
second essay describing your specific interest, the type of work you would like to pursue in this field, and how
you intend to pursue employment or volunteer work in this area (minimum 1200 words.)
CAGS in Educational Leadership and Management, CAGS in Interdisciplinary Studies: Reading Specialist,
Master of Education (except MEd Arts Education), Master of Arts in Teaching, and Post Baccalaureate
Certificate: Please complete an essay of no more than one page in response to one of the following
statements or questions:
1. Tell us about a positive situation in which you helped a person and made a significant difference
in that person’s life.
2. What are the most important factors in establishing a long-term working relationship with
students, friends, etc?
3. Tell us about a significant event that involved you in a teaching or helping role.
• Describe the situation as it occurred at the time.
• What did you do in that particular situation?
• How did you feel about the situation at the time you were experiencing it?
• How do you feel about the situation now?
• What would you change, if anything?
nWriting sample
This may include an undergraduate level term paper or published article and should be equivalent
to at least 10 typed, double-spaced pages and include footnotes and a bibliography.
s Copy of current U.S. RN License and a written two-part essay
t Copy of standard certification or vocational teacher approval
vCopy of initial teaching license in major (for professional track only)
H Copy of initial or professional teaching license
7Passing scores for the Communication and Literacy subtests of the MTEL
z Passing scores for the Communication and Literacy subtests of the MTEL OR copy of initial teaching license
 Successful completion of Fitchburg State University Nursing Portfolio Review for applicants who do not hold a BSN
µ A personal statement (maximum 300 words) that describes your goals and reasons for applying to the program
and should include information about previous course work, training or work experiences related to the program.
It should also specifically discuss the strengths you bring and the areas of competence you need to develop. One
of the following must also apply: 1) Submit proof of Master’s Degree from a fully regionally accredited institute of
higher education; 2) Be matriculated in a Fitchburg State University master’s degree program OR 3) Concurrently
submit a full application to a Fitchburg State University master’s degree program.
Additional requirement details can be found in the university graduate catalog at www.fitchburgstate.edu/catalog.
Application Mailing Address
The application and all supporting documents should be sent to:
Admissions Office, Fitchburg State University — 160 Pearl Street, Fitchburg, MA 01420
Complete this application form and mail it in the attached envelope, along with a check or money order payable to
Fitchburg State University ($40 for all applicants).
Please print in ink or type.
SECTION I: PERSONAL INFORMATION
Last Name (legal name) First Name Middle Initial Maiden Name
Mailing Address Street Address (if P.O. Box is given as mailing address)
City State Zip Country
Home Telephone Work Telephone Cell Telephone
Email Address Social Security Number (for reporting purposes, optional)
Gender (for reporting purposes, optional)
S
Male
S
Female
Date of Birth (for reporting purposes, optional) Month:_____ _____ Day:_____ _____ Year:_____ _____
Citizenship:
S
I am a U.S. citizen
S
I am a permanent resident (Please include a copy of your permanent resident card.)
S
I am not a U.S. citizen or permanent resident. Country of citizenship: ______________________________________________________________
If you are NOT a U.S. citizen or permanent resident: Are you currently in the United States?
S
Yes
S
No
If you are in the United States, what is your current visa status?
S
F1
S
F2
S
J1
S
J2
S
B1
S
B2
S
H1b
S
H2
S
Other: ___________________________________________________________
What visa status do you plan to hold while studying at Fitchburg State University?
S
F1
S
J1
S
H1b
S
H4
S
Other: _____________________________________________________________________________
Please list all relatives (and their relation to you) who are Fitchburg State graduates: __________________________________________________________________
__________________________________________________________________________________________________________________________________________
Ethnicity/Race (for reporting purposes, optional): Do you consider yourself to be Hispanic/Latino?
S
Yes
S
No
In addition, select one or more of the following racial categories to describe yourself:
S
American Indian/Alaskan Native
S
Asian
S
Black or African American
S
Cape Verdean
S
Native Hawaiian or Pacific Islander
S
White
I learned about Fitchburg State University through the following source(s):
S
Alumnus/a
S
Colleague
S
College Fair
S
Fitchburg State Recruiter
S
College Guidebook
S
Current Student
S
Friend
S
Internet
S
Relative
S
Radio/Newspaper Advertisement
S
Professor/Counselor
S
University website
S
Online advertisement
S
GCE Information Session
S
Other: ______________________
SECTION II: ALL APPLICANTS
Have you applied for admission to Fitchburg State University previously (graduate or undergraduate)?
S
Yes, (Semester/Year): _____________ /
S
No
Have you taken classes at or earned a degree from Fitchburg State University?
S
Yes, Degree, if applicable: ______________________________ /
S
No
Planned Entrance:
S
Fall (September)
S
Spring (January)
S
Summer (May) YEAR: 20______
Are you pursuing your degree through an off-campus location in collaboration with one of our extended campus partners?
S
Yes
S
No
If yes, please indicate which one:
S
Collaborative for Educational Services
S
Brine
S
Lowell Public Schools
S
MAVA
S
Teachers 21
S
Other: ________________________________________________________________
See Extended Campus Partners listing on last page of application
GRADUATE
Application for Admission
List three academic or professional references. At least one must be an academic reference.
Name ____________________________________________ Position: ___________________________________ Phone # ____________________________
Name ____________________________________________ Position: ___________________________________ Phone # ____________________________
Name ____________________________________________ Position: ___________________________________ Phone # ____________________________
SECTION III: COLLEGE AND EMPLOYMENT HISTORY
Please list all colleges you are currently attending and/or have attended and degrees received (including Fitchburg State University).
Degree/ Diploma Term/Year Term/Year
Name of College/University City and State Earned Studies Began Studies Completed
Employment
Current Employer: ________________________________________________ Position: ________________________________________________________
City: ____________________________________________________________ State: _________ Zip: ________________Country: _____________________
Work Phone: (___________) ________________________________________ May we contact you at work?
S
Yes
S
No
Applicants to Teacher Licensure Programs
Do you hold a license to teach in the Commonwealth of Massachusetts?
S
Yes
S
No
If yes, what type of license? (Please include a copy of your teaching license with your application.)
S
Preliminary license in: ________________________________________________________________ Grade Levels:_____________________
S
Initial license in: ____________________________________________________________________ Grade Levels:_____________________
S
Professional license in: _______________________________________________________________ Grade Levels:_____________________
S
Other (describe): ___________________________________________________________________ Grade Levels:_____________________
SECTION IV: TESTING INFORMATION
See the checklists for appropriate required tests for intended major. With the exception of the MTELs, if tests are more than five years old,
new tests will be required.
I took or plan to take the following admission exams. (Please include a copy of your test results.)
S
Graduate Management Admissions Test (GMAT): Date (Month/Year): ________/________ Score: ______________________________
S
Graduate Record Examination (GRE): Date (Month/Year): ________/________ Score: ______________________________
S
Miller’s Analogies Test (MAT): Date (Month/Year): ________/________ Score: ______________________________
S
Test of English as a Foreign Language (TOEFL): Date (Month/Year): ________/________ Score: ______________________________
S
International English Language Testing System (IELTS): Date (Month/Year): ________/________ Score: ______________________________
S
Massachusetts Test for Educator License (MTEL) Date (Month/Year): ________/________ Score: ______________________________
Communication and Literacy Skills - Reading
S
Massachusetts Test for Educator License (MTEL) Date (Month/Year): ________/________ Score: ______________________________
Communication and Literacy Skills - Writing
S
Massachusetts Test for Educator License (MTEL) Date (Month/Year): ________/________ Score: ______________________________
Subject Test(s):______________________________
SECTION V: INTENDED DEGREE
Please select ONE program only.
Certificate of Advanced Graduate Study (CAGS)
Educational Leadership and Management
S
School Principal PreK-6 (Initial Licensure)
l
H 7
S
School Principal 5-8 (Initial Licensure)
l
H 7
S
School Principal 9-12 (Initial Licensure)
l
H 7
S
Supervisor/Director (Initial Licensure) All levels
l
H 7
S
Non-Licensure
l
H
Interdisciplinary Studies
S
Applied Communication
S
Counseling/Psychology
S
Individualized Concentration
S
Reading Specialist
(Initial Licensure)—
ONLINE/HYBRID ONLY
l
H 7
Master of Arts
S
Biology
S
English Studies
S
English Studies: Gender Studies
S
History
n
Master of Arts in Teaching
S
Biology (Initial Licensure)
l
z
S
Biology (Professional Licensure)
l
v
S
English Studies (Professional Licensure)
l
v
S
English Studies (Non-Licensure)
l
v
S
History (Professional Licensure)
l
v
S
History (Non-Licensure)
l
Master of Business Administration
S
Accounting
S
Human Resources Management
S
Human Resources Management—
ONLINE
S
Management
S
Management—
ONLINE
Graduate Level Certificate Programs
S
Applied Communication Studies
S
Behavior Analyst—
ONLINE/HYBRID ONLY
µ
S
Educational Technology
S
Fine Arts Director
S
Forensic Nursing—
ONLINE ONLY
l s
S
Not-for-Profit Management
S
Not-for-Profit Management:
Leadership in Public Administration and Government
S
Reading Specialist
(Initial Licensure) All levels—
ONLINE/HYBRID ONLY
H 7
Post-Baccalaureate Certificates for Initial Teaching Licensure
S
Biology (8-12)
l
7
S
English Studies (8-12)
l
7
S
Math (8-12)
l
7
S
Technology/Engineering Education (5-12)
l
7
Master of Education
S
Arts Education (Non-Licensure)
l
S
Curriculum and Teaching (Non-Licensure)
l
Early Childhood Education
S
PreK-2 (Initial Licensure)
l
z
S
Professional Licensure
l
H
Educational Leadership and Management
S
Non-Licensure
l
H
S
Supervisor/Director (Initial Licensure) All levels
l
H7
S
School Principal PreK-6 (Initial Licensure)
l
H7
S
School Principal 5-8 (Initial Licensure)
l
H7
S
School Principal 9-12 (Initial Licensure)
l
H7
Elementary Education
S
1-6 (Initial Licensure)
l
z
S
Professional Licensure
l
H
Middle School Education
S
5-8: Math/Science (Initial Licensure)
l
z
S
5-8: Humanities (Initial Licensure)
l
z
S
Math/Science (Professional Licensure)
l
H
S
Humanities (Professional Licensure)
l
H
S
Occupational Education (Non-Licensure)
l
t
Science Education
S
Professional Licensure
l
v
Special Education—
ALL ONLINE/HYBRID ONLY
S
Guided Studies (Moderate Disabilities Professional Licensure)
l
v
S
Guided Studies (Severe Disabilities Professional Licensure)
l
v
S
Guided Studies, Individualized Concentration (Non-Licensure)
l
S
Guided Studies, Individualized Concentration,
Dyslexia Specialist (Non-Licensure)
l
S
Reading Specialist (Initial Licensure) All levels
l H 7
S
Reading Specialist (Non-Licensure)
l H
S
Teacher of Students with Moderate Disabilities
PreK–8 (Initial Licensure)
l
z
S
Teacher of Students with Moderate Disabilities
5–12 (Initial Licensure)
l
z
S
Teacher of Students with Severe Disabilities
(Initial Licensure) All levels
l
z
Master of Science
Applied Communication
S
Applied Communication Studies
S
Health Communication
S
Technical and Professional Writing
S
Computer Science
Counseling
S
Mental Health Counseling
l
S
School Guidance Counseling: PreK-8 (Initial Licensure)
l
z
S
School Guidance Counseling: 5-12 (Initial Licensure)
l
z
S
Forensic Nursing—
ONLINE ONLY
l s
See Graduate Application Checklist page for the key to symbols for additional requirements.
Adult and Community Education
of Martha’s Vineyard
35 Greenwood Avenue (508) 693-9222
Vineyard Haven, MA 02568 [email protected]
www.acemv.org
M.Ed. Curriculum and Teaching
Catherine Leahy-Brine
Educational Consultants
P.O. Box 1060 (781) 331-8826
Brockton, MA 02303 [email protected]
www.catherineleahybrine.com
M.Ed. Curriculum and Teaching
M.Ed. Educational Leadership and Management
CAGS Educational Leadership and Management
M.Ed. Special Education: Reading Specialist
CAGS Interdisciplinary Studies: Reading Specialist
Collaborative for
Educational Services (CES)
97 Hawley Street (413) 586-4900
Northampton, MA 01060 [email protected]
www.teachinmass.org
M.Ed. Curriculum and Teaching
CAGS Interdisciplinary Studies: Individualized Concentration
Lowell Public Schools
155 Merrimack Street (978) 446-7407
Lowell, MA 01852 [email protected]
www.lowell.k12.ma.us
M.Ed. Curriculum and Teaching
Massachusetts Association
of Vocational Administrators (MAVA)
Robert Packard (508) 879-5400 x277
c/o Joseph P. Keefe Tech. School [email protected]
750 Winter Street, Framingham, MA 01702
www.mava.us
M.Ed. Curriculum and Teaching
M.Ed. Occupational Education
Teachers 21
Jennifer Antonucci (781) 416-0980
Suite 220, 34 Washington St. [email protected]
Wellesley, MA 02481
www.teachers21.org
M.Ed. Curriculum and Teaching
EXTENDED CAMPUS PARTNERS
SECTION VI: DISCLOSURES
Have you been placed on probation, suspension or dismissal from a graduate program?
S
Yes
S
No
Have you been convicted of a felony?
S
Yes
S
No
If you answered yes to either question, you must provide a written explanation of the circumstances.
If you have been placed on probation, suspension, or dismissal from a graduate program, you must provide a letter of explanation from the dean
of your previous college.
SECTION VII: SIGNATURE
I understand that information about applicants furnished to Fitchburg State University will be kept confidential and will be released only to public higher
education system personnel authorized by the Massachusetts Department of Higher Education. I hereby certify that the information furnished on the application
form is complete and accurate.
Applicant’s Signature Date
This list of Extended Campus Partners and programs is subject to change.
Transfer credits will not be reviewed without official transcripts on file. Requests for transfer credit must be submitted with your application for
admission. The university accepts a maximum of 6 semester hours in transfer credits from regionally accredited institutions with the approval of the
Graduate Program Chair. Transferred courses are only valid if taken within six years of your anticipated date of graduation.
Applicant’s Last Name (legal name) First Name Middle Initial Maiden Name
Mailing Address: (P.O. Box, RFD, Street) City State/Province Zip Code Country (If other than USA)
Home Telephone Number Work Telephone Number
Social Security Number Expected Year of Graduation Email Address
I request the following course(s) be transferred into the program to which I am applying. I understand that the course(s) must be from a regionally
accredited institution, taken for graduate credit, that I must have received a grade of “B” (3.0) or better, and that the course(s) must not have been used
to fulfill requirements for another degree.
NOTE: The university accepts a maximum of 6 semester hours in transfer credits from regionally accredited institutions.
Send official transcripts to: Admissions Office, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420
Courses From Other Institutions
Course # of Semester/
Institution Number Course Title Credits Year Taken Program Chair Use ONLY
S
App. FSU equivalent
S
Not App.
S
App. FSU equivalent
S
Not App.
Twelve semester hours of Fitchburg State University credit taken within a year prior to the student’s admission may be applied to the degree program with
the approval of the Program Chairperson. No more than six semester hours of course work at the 6000 level may be applied toward a degree program.
Fitchburg State University Courses
Course Credits Semester/
Institution Number Course Title 12 max. Year Taken Program Chair Use ONLY
S
App. Used as elective
S
Not App.
S
Yes
S
No
S
App. Used as elective
S
Not App.
S
Yes
S
No
S
App. Used as elective
S
Not App.
S
Yes
S
No
S
App. Used as elective
S
Not App.
S
Yes
S
No
Applicant’s Signature Date
Graduate Program Chair Signature Date
Dean’s Signature Date
Return form to: Admissions Office, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420 • (800) 705-9692
Fitchburg State University
Fitchburg State University
Fitchburg State University
Fitchburg State University
Request for Transfer
of Graduate Credit
APPLICANT’S SECTION
This part is to be completed by the applicant prior to giving the form to the evaluator.
Last Name (legal name) First Name Middle Initial Last 4 digits of Social Security Number
Home Street Address City State Zip Country
Intended Graduate Program of Study:
Waiver Selection and Signature:
S
I waive the right provided by the Family Education Rights and Privacy Act of 1974 to view this letter of recommendation.
S
I do not wish to waive this right. I wish to retain the right to view this letter of recommendation.
Applicant’s Signature: ______________________________________________________________________Date: ________________________
EVALUATOR’S SECTION
The person whose name appears above is applying to a graduate program at Fitchburg State University.
We would appreciate your candid appraisal of this applicant relative to admission. The actual signed letter
of recommendation that accompanies this form must be submitted on professional letterhead.
As required by the Family Education Rights and Privacy Act of 1974, a student may elect to waive the
privilege of viewing this recommendation form. If the student has not waived this right in the section
above, you should consider this form to be non-confidential.
Name of Person Making the Evaluation Last First Middle
Organization/Institution Relationship to Applicant (check one):
S
Current/Former Employer
S
Current/Former Instructor
Position/Title Phone Number
Business Address City State Zip
Evaluator’s Signature
1. How long and in what capacity have you known this applicant?
Graduate Letter
of Recommendation
for Admission
2. Evaluate this applicant by checking (
3
) the scales below, relative to other people you have known in a similar capacity.
Excellent Above Below No Opportunity
(Top 10%) Average Average Average to Evaluate
Intellectual Ability (General Thinking Skills)
Discipline-Specic Knowledge
Interpersonal Skills
Eectiveness in Written Communication
Eectiveness in Oral Communication
Leadership Ability
Ethical Integrity
Motivation/Initiative
Promise as a Graduate Student
3. Narrative: Describe this applicant in terms of: strengths and areas needing development; potential to achieve in graduate studies; special qualities or
experiences that lend support to this applicant’s acceptance into this graduate program.
PLEASE ATTACH TO THIS FORM A SIGNED WRITTEN NARRATIVE PRINTED ON PROFESSIONAL LETTERHEAD.
Thank you for completing the recommendation on behalf of the student. Please return form and written statement to:
Admissions Office, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420
APPLICANT’S SECTION
This part is to be completed by the applicant prior to giving the form to the evaluator.
Last Name (legal name) First Name Middle Initial Last 4 digits of Social Security Number
Home Street Address City State Zip Country
Intended Graduate Program of Study:
Waiver Selection and Signature:
S
I waive the right provided by the Family Education Rights and Privacy Act of 1974 to view this letter of recommendation.
S
I do not wish to waive this right. I wish to retain the right to view this letter of recommendation.
Applicant’s Signature: ______________________________________________________________________Date: ________________________
EVALUATOR’S SECTION
The person whose name appears above is applying to a graduate program at Fitchburg State University.
We would appreciate your candid appraisal of this applicant relative to admission. The actual signed letter
of recommendation that accompanies this form must be submitted on professional letterhead.
As required by the Family Education Rights and Privacy Act of 1974, a student may elect to waive the
privilege of viewing this recommendation form. If the student has not waived this right in the section
above, you should consider this form to be non-confidential.
Name of Person Making the Evaluation Last First Middle
Organization/Institution Relationship to Applicant (check one):
S
Current/Former Employer
S
Current/Former Instructor
Position/Title Phone Number
Business Address City State Zip
Evaluator’s Signature
1. How long and in what capacity have you known this applicant?
Graduate Letter
of Recommendation
for Admission
2. Evaluate this applicant by checking (
3
) the scales below, relative to other people you have known in a similar capacity.
Excellent Above Below No Opportunity
(Top 10%) Average Average Average to Evaluate
Intellectual Ability (General Thinking Skills)
Discipline-Specic Knowledge
Interpersonal Skills
Eectiveness in Written Communication
Eectiveness in Oral Communication
Leadership Ability
Ethical Integrity
Motivation/Initiative
Promise as a Graduate Student
3. Narrative: Describe this applicant in terms of: strengths and areas needing development; potential to achieve in graduate studies; special qualities or
experiences that lend support to this applicant’s acceptance into this graduate program.
PLEASE ATTACH TO THIS FORM A SIGNED WRITTEN NARRATIVE PRINTED ON PROFESSIONAL LETTERHEAD.
Thank you for completing the recommendation on behalf of the student. Please return form and written statement to:
Admissions Office, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420
Thank you for completing the recommendation on behalf of the student. Please return form and written statement to:
Admissions Office, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420
APPLICANT’S SECTION
This part is to be completed by the applicant prior to giving the form to the evaluator.
Last Name (legal name) First Name Middle Initial Last 4 digits of Social Security Number
Home Street Address City State Zip Country
Intended Graduate Program of Study:
Waiver Selection and Signature:
S
I waive the right provided by the Family Education Rights and Privacy Act of 1974 to view this letter of recommendation.
S
I do not wish to waive this right. I wish to retain the right to view this letter of recommendation.
Applicant’s Signature: ______________________________________________________________________Date: ________________________
EVALUATOR’S SECTION
The person whose name appears above is applying to a graduate program at Fitchburg State University.
We would appreciate your candid appraisal of this applicant relative to admission. The actual signed letter
of recommendation that accompanies this form must be submitted on professional letterhead.
As required by the Family Education Rights and Privacy Act of 1974, a student may elect to waive the
privilege of viewing this recommendation form. If the student has not waived this right in the section
above, you should consider this form to be non-confidential.
Name of Person Making the Evaluation Last First Middle
Organization/Institution Relationship to Applicant (check one):
S
Current/Former Employer
S
Current/Former Instructor
Position/Title Phone Number
Business Address City State Zip
Evaluator’s Signature
1. How long and in what capacity have you known this applicant?
Graduate Letter
of Recommendation
for Admission
2. Evaluate this applicant by checking (
3
) the scales below, relative to other people you have known in a similar capacity.
Excellent Above Below No Opportunity
(Top 10%) Average Average Average to Evaluate
Intellectual Ability (General Thinking Skills)
Discipline-Specic Knowledge
Interpersonal Skills
Eectiveness in Written Communication
Eectiveness in Oral Communication
Leadership Ability
Ethical Integrity
Motivation/Initiative
Promise as a Graduate Student
3. Narrative: Describe this applicant in terms of: strengths and areas needing development; potential to achieve in graduate studies; special qualities or
experiences that lend support to this applicant’s acceptance into this graduate program.
PLEASE ATTACH TO THIS FORM A SIGNED WRITTEN NARRATIVE PRINTED ON PROFESSIONAL LETTERHEAD.
Thank you for completing the recommendation on behalf of the student. Please return form and written statement to:
Admissions Office, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420