Name:
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Social Security Number:
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Date:
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Address:
________________________________________________________________________________

Address to which communication should be sent after the award date, March 15:
________________________________________________________________________________

Telephone number where you may reach after March 15:
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I propose to work toward ___________ degree in _______________________ .

I have attended the following colleges and universities (college attended/dates inclusive/degree received):
________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

I am currently enrolled in the University of Georgia Graduate School: Yes ___________ No ___________

I expect to be admitted to the Graduate School for entrance ______________ Semester, Year ____________ .

I have taken the ____________________ (name of examination) during the past five years, and my scores are listed below.

Graduate Record Examination: Verbal __________ Quantitative __________ Analytical __________

Graduate Management Admission Test: Total Score ___________

I am planning to take the _____________________ (name of exam) on ______________________ (date).

Honors and other evidence of scholarships:
________________________________________________________________________________

________________________________________________________________________________

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In support of this application, I wish to make the following statement concerning my personal objectives in doing graduate work (attach additional sheet, if necessary):
________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

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The following three persons have been requested to submit reference forms or write letters of recommendation on my behalf and to send the forms or letters directly to the departmental graduate coordinator. (Letters of recommendation or reference forms should be written by persons qualified to give judgment on the scholarly attainment and promise of the applicant. It is the applicant's responsibility to see that these letters are sent to the graduate coordinator in the department to which he/she has applied no later than February 1.)
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________________________________________________________________________________

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If I accept a Graduate School Assistantship or Departmental Assistantship at The University of Georgia, I agree to abide by all policies and regulations which apply to such assistantships.

Signed:
________________________________________________________________________________

Date:
________________________________________________________________________________