HOWARD UNIVERSITY
SCHOOL OF SOCIAL WORK
APPLICATION FOR GRADUATE STUDY
MASTER OF SOCIAL WORK Degree Program
Related Files: Application Instructions  |  Policy on Equal Opportunity 

Application Fee (Non-refundable): $45.00

For Office Use Only
 |       |       |      |       |       |       |

IDENTIFICATION NUMBER

PRINT OR TYPE - Use codes where indicated

SOCIAL SECURITY NUMBER:
_________/______/__________		 Application for (semester and year)
Fall 20__   Spring 20__   Summer 20__		 Date of birth
_______/_______/_______
Month    /     Day     /    Year
Gender (optional)  [     ]  Male      [     ] Female Legal name   [     ] Mr.     [     ] Ms. 

Name:_________________________
                 Last (family or surname) name

 ___________________
First name		 _____________________
Middle		 _______________________
Previous last name(s)

Permanent address: __________________________________________________________________________________________
                                                                                                                Number and street
City: _________________________ State/Country: ______________________ Zip code: _________________________

Mailing address: _____________________________________________________________________________________
                                                                                                               Number and Street
City: _________________________ State/Country: ______________________ Zip code: _________________________
Day phone no.: (____)  _____- ________  Home phone no.:  (____)  _____- ________  E-Mail address:__________________
Fax no.:  (____)  _____- ________
[     ] U.S. citizen

[     ] Permanent resident

 Citizenship
[__________]
  U.S. State or Country 		 Birthplace
[__________]
   U.S. State or Country 		 [     ] VISA___Type
Are you a veteran of the U.S. Uniformed Services?      [     ] Yes                   [     ] No                During Vietnam [     ]
College/School
[__________]
 C Codes		 Major
[__________]
 C Codes		 Degree sought
[__________]
D Codes		 Indicate specific program within
the department
______________________________
Classification:   [     ] Regular        [     ] Unclassified (non-degree)
Status: [     ] New entrant     [     ] Transfer     [     ] FSR (Former student returning)
 Enrollment:   [     ] Fulltime        [     ] Part Time

List all universities and colleges attended. List institutions where highest degree was obtained first.
Howard University students: List Howard University and all other institutions.

Institution School
code		 City State Country Major Degree
received		 Dates
From Mo/Yr To Mo/Yr
                 
                 
                 
                 
 
Have you previously applied for admission to Howard University?    [     ]  Yes     [     ]  No
If Yes, for which semester was last application submitted:  Fall 20 ______      Spring 20 _____     Summer 20 _____
Former Howard University students indicate last semester enrolled:    Fall 20 ______      Spring 20 _____     Summer 20 _____
Howard University school/college in which you were last enrolled: C Codes[__________]   Major C Codes[__________]
Howard University identification number (ID): ____________________
NAME UNDER WHICH YOU LAST ATTENDED HOWARD UNIVERSITY IF DIFFERENT FROM NAME
PRESENTLY USED.

______________________________________________________________
Last
_____________________________________________________________
First
_______
MI
If you answer yes to any of the next four (4) questions, attach a letter giving details.

a)  Have you been arrested? [    ] Yes [    ] No
b)  Have you been convicted of any crime (other than traffic violations) or been sentenced to a correctional or penal Institution?
     [    ] Yes [    ] No
c)  Has disciplinary action been taken against you at any educational institution? [    ] Yes [    ] No
d)  Has academic action been taken against you at any educational institution attended? [    ] Yes [    ] No

What most influenced your decision to attend Howard University?  E Codes[__________]

List family members (exclude spouse) who have attended Howard University. (optional)
____________________________________________________________
Name		 __________________________________________________________
Relation		 ________________
Class of
____________________________________________________________
Name		 __________________________________________________________
Relation		 ________________
Class of
____________________________________________________________
Name		 __________________________________________________________
Relation		 ________________
Class of
As indicated by my signature, I understand that withholding information required on this application or giving false information may make me ineligible for admission
to the University or subject to dismissal when the same is made known regardless of classification. With this understanding, I certify that all of the above statements and information included are correct and complete; and, if admitted to Howard University, I agree to abide by its policies, rules and regulations.

Signature of applicant __________________________________________________________ Date _____________________

Please return the completed form and $45 application fee (payable to Howard University) and required application materials directly to:

SCHOOL OF SOCIAL WORK
Howard University
601 Howard Place, NW 
Washington, DC 20059
 

For Questions, Please Contact Mrs. Beverly Washington By Phone at (202) 806-7300, or By E-mail.