Preliminary Application for Graduate Admission

Completion of this form indicates your intent to apply to Keuka College's graduate program. Once you have completed this form, you will be directed to instructions on how to submit your $30 application fee and download the complete graduate admissions packet.

Program & Location Information

For which program are you applying?
M.S., Management
M.S., Criminal Justice Administration

During which term would you like to begin attending ASAP classes?
Spring 2009
Summer 2009
Fall 2009

What is your preferred location of study?

Last Name	First Name	Middle Name	Former Last Name (if any)

Date of Birth

Residential Street Address		Apt. #

City		State	Zip

Home Phone Number		Cellular or Work Phone Number

Home E-mail Address		Work E-mail Address

Undergraduate Degree Awarded		Undergraduate Institution

Name of Employer		Street Address

City		State	Zip

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Keuka College Center for Professional Studies
One Keuka Business Park • Penn Yan, NY 14527
adlearn@mail.keuka.edu
(866) 255-3852, toll-free
(315) 279-5407, fax

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Commission on Social Work Education (CSWE), 1725 Duke St., Suite 500, Alexandria, VA 22314-3457. Phone (703) 683-8080.