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Graduate Certificate Information Request Form

Departmental Information Form (DIF) informs members of the Health Care Administration or Nonprofit Leadership & Administration Admissions Committee about your professional, academic and extracurricular experience, and your career aspirations.

* = Required

Please select Graduate Certificate

Health Care Administration
Nonprofit Leadership & Administration


Candidate Information

* First Name:

* Middle Initial:

* Last Name:

Mailing Address:
City:
State:
Zip Code:

Home Phone(please include area code)

Alternate Phone:

* E-Mail Address (this will be used to send you information about your application):

 

Educational and Professional Status

Current Status (check all that apply):
Employed Full Time
Employed Part Time
Unemployed/Retired
Part Time Student
Full Time Student

Educational Background (check all that apply and fill in information)

Completed Bachelors Degree 

    Institution:
    Field:
    Year:

Current Graduate Degree

    Degree:
    Institution:

Completed Masters Degree

    Institution:
    Field:
    Year:

Work Title and Address (if applicable)

Position Title:

Agency / Firm / Organization:

Location (city and state):    
Work Phone:


Other Information

For scheduling purposes, please provide the following information:

Branch Campus at which you plan to take the majority of your courses if admitted:

Kalamazoo                 Lansing                 Battle Creek

- End of Departmental Information Form -

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Resume

Please submit your current resume by cutting and pasting in the box provided or sending it as an attachment. The resume must include your educational background and the positions you have held over the past ten years. Indicate the title of each position, the agency or firm by which you were employed, and the duration of each employment. 

You are encouraged to supplement the resume with additional materials (e.g. awards or accomplishments, commendations, letters of recommendation, etc.) that provide the Admissions Committee with essential information about you and your interest in the HCA certificate program. Individuals who have not distinguished themselves academically in their post-secondary education are especially encouraged to submit evidence of work-related achievement.


Essay

Each applicant must prepare a one-page biographical essay that discusses their reasons for applying to the HCA program, their professional goals, an assessment of strengths and challenges, and any life experiences that might be useful in work as a healthcare professional.  This essay may be submitted in the box provided or as an attachment. The Admissions Committee members read this essay to assess your ability to express yourself clearly and concisely, to utilize proper grammar and punctuation, and to present your thoughts in a logical manner.