SSU Extended Education: Graduate Application Form

This form is currently under construction. Please contact Beth Warner if you have any questions.

Accom. Status Enroll Status Res. Status Citizenship
Perm. Res. CC trans. Degree Held Inst. of Origin
Trans. units in progress Miscellaneous


We encourage you to attend one of our Information Meetings to learn more about these programs. Check the Information Meetings web site for current dates for graduate programs.

This form is ONLY for mail or fax. Fill in, print, then mail or fax to: SSU Extended Education, 1801 E. Cotati Ave., Rohnert Park, CA. 94928

Attach $55 (U.S.) application fee payable to SSU. The fee is nonrefundable and may not be tranferred to another term. Response to each item is mandatory unless otherwise indicated.


  In addition to this form, individual graduate programs may require supplemental application materials. (See item 14a.)
3. Please check the program to which you are applying:
Use of Social Security Number:
SSU uses the social security number as the identifier for student records maintained in your association with the campus and, if needed, to help collect debts owed the university. Applicants are required to include their social security number in designated places on applications for admission pursuant to authority contained in Title 5, California Code of Regulations, Section 41201.
If you do not have a social security number at the time you file the application, leave the item blank; the campus will assign a substitute number.
If you have previously applied to or attended this campus, please list:
Pick a date



7a. Phones   Check preferred number
Home Phone
Daytime Phone
Cell Phone

10. Name of intended degree
11. Degree Objective Master's
12. What was your baccalaureate major/minor?

14. Print the names and locations of all colleges and universities attended, even if no coursework was completed. Begin with the last institution attended. Attach a separate sheet if you need more space. For units in progress and planned, see the next list below.
Location From (mm/yy)
To (mm/yy)
Transferable units completed
Degree received
Date to be received
Office Use Only

14a. Please send two official, sealed transcripts showing the most recent 60 semester units you have attempted (even if unrelated to your major), as well as award of the bachelor's degree (include Summer and Extension transcripts) to SSU Extended Education, 1801 E. Cotati Ave., Rohnert Park, CA 94928-3609. Add "attention to" on the envelope and use the appropriate name from the list below:

Program to which you are applying:

Contact email:

MA Spanish Karen Fischer
MA Organization Development
NOTE: The MA Organization Development program has a Departmental Application to OD Program [pdf format]. Please complete both this application and the additional form if you are an applicant to that program. Please include them together in one envelope for mailing to the above address.
Karen Fischer
MA Psychology, Depth Psychology
NOTE: The MA Psychology, Depth Psychology program has a Program Application [pdf format]. Please complete both this application and the additional form if you are an applicant to that program. Please include them together in one envelope for mailing to the above address.
Karen Fischer
MS Computer and Engineering Science Susan McFeeters


15. List below college courses in which your are currently enrolled and additional courses you plan to complete (including summer school) before entering the program. Attach a separate sheet if more space is needed.
 Courses in Progress:
 Institution  Term/Year  Dept. Course No. and Title
 Unit Value

 Courses Planned:
 Institution  Term/Year  Dept. Course No. and Title
 Unit Value

16. I have taken the Written English Proficiency Test or equivalent junior-level writing exam.
17. Employment History: You may omit employment not relevant to your professional academic goal. Include naure of work and dates.

If you wish to apply for financial assistance, contact the Financial Aid Office at (707) 664-2389 for an application form or check the Financial Aid website:

Pick a date
Pick a date
20. Enter your ethnic/racial identity. To conform with the new guidelines of the Federal Office of Management and Budget, the CSU must collect from applicants detailed information about their ethnic and racial backgrounds.
If you select "yes" in Question 20a, a response to Question 20b is required. Please do not select more than one response in Question 20b as only ONE response is allowed. After completing Question 20b, please answer Questions 20c and 20d. If you have selected "no" or "decline to state", do not answer Question 20b.)

20b. If you indicated (above that you consider yourself Hispanic or Latino, please select the ONE category below that best describes your background:

Costa Rican

Dominican (Republic)

Puerto Rican

Other Central American
Other South American
Other Hispanic or Latino
If Other, specify:

20c. What is your race? (Mark one or as many races below as appropriate for you.) All graduate applicants must respond to Question20c. If you select "decline to state", then you cannot choose any other boxes. The U.S. Census identifies the followin races: White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or Pacific Islander. These racial categories, as well as many sub-categories, are listed below. You may mark as many races as are appropriate to you. Please mark only one sub-category for each race that you select.