Application for Graduate Education Post-Master's certificate program and Autism certificate program

General Information

St. Thomas Aquinas College
Office of Admissions
125 Route 340
Sparkill, NY 10976
(845)398-4105
www.stac.edu
Admissions@stac.edu

Please note the following admission requirements:

Post-Master's certificate program in Literacy, Special Education or TESOL: Master's Degree and valid teaching certification required.
Autism certificate program: Official transcripts from undergraduate and/or graduate institutions required.

Upon completion of this form, applicants may submit a copy of teaching certification via email or regular mail to the Office of Admissions. Official transcripts from a Master's Degree and/or other institutions should be submitted directly to the Office of Admissions from the issuing institution.

First Name

M.I.

Last Name

Other/Previous Name

Social Security Number

Mailing Address: Street

Apt. #

City

State

Zip Code

Country

Home Phone

Cell Phone

E-mail Address

Date of Birth

Gender

MaleFemaleOther Prefer not to disclose

Citizenship

US CitizenPermanent Resident (Green Card)I will need an I-20 for F-1 student statusOther

Has a relative of yours ever attended St. Thomas Aquinas College?

NoYes

If yes, please indicate relationship:

Educational Background

List all Previously attended colleges.

College 1: Name

College 1: City, State

College 1: Dates of Attendance

College 1: Degree(s) Received or Number of Credits Completed

College 2: Name

College 2: City, State

College 2: Dates of Attendance

College 2: Degree(s) Received or Number of Credits Completed

College 3: Name

College 3: City, State

College 3: Dates of Attendance

College 3: Degree(s) Received or Number of Credits Completed

College 4: Name

College 4: City, State

College 4: Dates of Attendance

College 4: Degree(s) Received or Number of Credits Completed

Additional Colleges Attended:

Educational Honors Received:

St. Thomas Aquinas College does not discriminate in its educational programs, activities or employment practices based on race, color, national origin, sex, sexual orientation or expression, disability, age, religion, ancestry, genetic information, marital status, veteran status or any other legally-protected category. Announcement of this policy is in accordance with State and with Federal law, including Title VI and Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination in Employment Act of 1967 and the Americans with Disabilities Act of 1990. For more information, please contact:

EEO, Section 504/ADA and Title IX Compliance Officer, 125 Route 340, Sparkill, NY 10076, 845-398-4044.

I understand that if I was born on or after January 1, 1957 and if I enroll for 3 or more credits, I must provide the College

with proof of immunization against measles, mumps and rubella. My failure to comply with this New York State law within

30 days from the start of the semester will result in my disenrollment from classes without refund of tuition and fees.

I Certify that the information in this application is true and complete to the best of my knowledge. The below text serves as Applicant's Signature:

Date: