Post-Graduate Certificate Application Please complete the following information as thoroughly as possible. Required fields are denoted by (*). You are required to provide Indiana Tech with transcripts from the college or university at which you earned your bachelor’s degree and master’s degree. You also may be asked to provide transcripts from other institutions to aid in the admissions decision. In addition to this application form and transcripts, you must submit a current résumé and an original essay. Please complete the following information as thoroughly as possible. Required fields are denoted by (*). In order to pursue the Post-Graduate Certificate in Global Leadership, students must have completed a master’s degree.Personal InfoFirst Name* Middle Initial Last Name* Preferred Name Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country County of Residence Phone*Phone Type*CellHomeWorkOtherSecondary PhoneSecondary Phone TypeCellHomeWorkOtherEmail* Legal Gender* Male Female Legal gender is required for federal reporting purposes.Citizenship* Citizenship/Residency Status* Nonresident Alien Resident Alien US Citizen Are you a veteran or member of the US military or a dependent of a veteran or member of the US military?* Yes No Date of Birth* MM slash DD slash YYYY Place of Birth Select EthnicityHispanic or LatinoNot Hispanic or Latino(Optional, will be used for statistical purposes only)Select the following race(s) you identify as: American Indian or Alaskan Native Asian Black or African-American Native Hawaiian or Other Pacific Islander White Academic PreferencesSelect a concentration* Organizational Leadership Higher Education Administration Organizational Leadership/Higher Education Global Health Leadership Business Administration (for MBA graduates only) Start Date PreferenceClick here to access PhD Session DatesPreferred Start DateSession 1 (August)Session 2 (October)Session 3 (January)Session 4 (March)Session 6 (May)Previous EducationPlease list all colleges or universities at which you earned a bachelor’s degree at as well as all colleges and universities which you attended as a graduate student. Admission to the doctoral division of Indiana Tech requires you to have earned a master’s degree from a regionally accredited institution.University Name* State* Graduation Year* Degree Earned* Major* GPA* Would you like to add another college experience? Yes No University Name* State* Graduation Year* Degree Earned* Major* GPA*Would you like to add another college experience? Yes No University Name* State* Graduation Year* Degree Earned* Major* GPA* Would you like to add another college experience? Yes No University Name* State* Grad Year*Degree Earned* Major* GPA*Have you requested that transcripts be sent to Indiana Tech?* Yes No Please mail your transcripts to the following address: Ph.D. Program Indiana Tech 1600 E. Washington Blvd. Fort Wayne, IN 46803 Financial InformationWhile it is ultimately the responsibility of each student to finance his or her own education, Indiana Tech will work with third parties to try to aid students in need of financial assistance. Please indicate which sources of financial aid you will be using so that we may better assist you.Financial Aid Sources Employer Tuition Assistance Veterans/Military Benefits Student Loans Other If you are in need of financial aid, you can submit the Free Application for Federal Student Aid. This form is required for all government aid and student loan programs. For more information about the various aid programs you can call the financial aid office at 260.422.5561, ext. 2334.Additional Application MaterialsYou must submit a current résumé including educational record, employment history, and relevant accomplishments, publications, presentations, and professional contributions.Current Résumé (PDF)*Accepted file types: pdf, Max. file size: 25 MB.You must submit an original essay* of between 500-1000 words that addresses: how the degree will assist with professional growth the global leadership and research aspect of the degree area of intended research/interests identify which current faculty members align with your intended area of research The essay should express a coherent position and demonstrate your written communication and critical thinking skills. *Use of APA 7th edition formatting is required.Original Essay (PDF)*Accepted file types: pdf, Max. file size: 25 MB.CommentsPlease specify any additional comments or clarifications related to your application.How did you hear about Indiana Tech?BillboardDirect Mail-CorporateDirect Mail-StudentDrive ByEvent-CorporateEvent-Ed Fair-ShowEvent-SpecialInternet-Indiana TechInternet-OtherPrint-MagazinePrint-NewspaperPrint-OtherPrint-PhoneBookRadio SpotReferral-CorporateReferral-OtherReferral-StudentTech GraduateTelevision SpotOtherPlease indicate how you heard about Indiana Tech Payment OptionsEach Ph.D. student must select a payment option. This gives the Business Office the information needed to process your tuition account. View a description of each option.Select a payment option.* Pre-pay Financial Aid Post 911 GI Bill ® VA Vocational Rehabilitation Military Tuition Assistance Direct Billing Voucher/Authorization Form Process Deferment for Employer Assistance If your military benefits do not cover full tuition, how will you pay the difference? Financial Aid Deferred Payment Date FAFSA filed* MM slash DD slash YYYY Employer* Employer phone number* Employer contact name* PoliciesPlease read the information carefully. After reading, check the boxes to confirm that you understand the policies.Non-Discrimination Policy Indiana Tech admits students without regard to race, color, national or ethnic origin, or disability to all rights, privileges, programs, and activities generally accorded to or made available to students at the school. Indiana Tech does not discriminate on the basis of race, color, national or ethnic origin, or disability in administration of its educational policies, admissions policies, scholarship, loan programs and athletic and other school administered programs. Indiana Tech will make reasonable accommodations for qualified individuals with a disability so that such individuals can enjoy the same access to services, programs or activities as other non-disabled individuals.Acknowledgment* I have read and acknowledged the Indiana Tech Non-Discrimination Policy. Indiana Tech Verification Agreement By signing my first and last name below, I do hereby certify that: all the information listed on this application is, to the best of my knowledge, accurate and truthful. I have elected to pay for my tuition as selected above. I understand that my account is my responsibility, regardless of whether or not I receive payment from my employer or other financial assistance and I agree to follow Indiana Tech’s payment policies. I understand that in the event my account is more than 30 days past due I will be assessed a $50.00 late charge per month on the past due balance. Due to lack of payment, the university may give my account to an outside agency to seek restitution. Furthermore, in the event the university has to incur any expenses collecting this account, I agree to pay all the costs of collection. This includes, but is not limited to, collection agency fees up to 50%, court costs, and/or any reasonable attorney fees. I authorize the university to release financial information about my account to those involved with collecting the balance due. Acknowledgment* I have read and agreed to the Indiana Tech Verification Agreement. Initials* Payment InformationThere is a $50 processing fee for this application. Please select how you would like to pay. Pay Now Pay via Check Please take your payment to your local Indiana Tech location, or mail a check to: Ph.D. Program Indiana Tech 1600 E. Washington Blvd. Fort Wayne, IN 46803 You will be forwarded to our payment processor after submitting your application.
