Information For

If there are changes to any of the information contained on this application after submission, it is your responsibility to notify Extended Learning at elapps@csusm.edu.

Fields marked with a RED * are required fields.

DO NOT SUBMIT UNTIL YOU HAVE FULLY COMPLETED THE APPLICATION.

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2 Year
3 Year

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Please provide full middle name
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If None, type in N/A
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Number, Street, Apt or unit # or P. O. Box
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Please include area code
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If applicable

*If different than mailing address

OPTIONAL; used for statistical reports and identification of scholarships.


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Provide name and phone number
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Yes*
No


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Yes*
No



List chronologically all colleges/universities you have attended, beginning with the most recent.
Please type "N/A" for fields in which you do not list a college/university you have attended.
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Academic Prerequisites:
Minimum GPA of 3.0 in the last 60 semester units (or 90 quarter units) of undergraduate coursework; completion of an undergraduate course in statistics with a grade of "C" or better is required.
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(Last 60 semester units or 90 quarter units)
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Important note regarding field placements: Please read carefully.
Field placements are required for the MSW program. Please be advised that field placements must be planned in accordance with state and federal laws, and with consideration of field placement agency policies. Most field placement agencies require security clearance evaluations, background checks, Live Scan fingerprinting, drug screens, etc., to ensure suitability of interns for placement in their agencies. In addition, some agencies require physical examinations, TB tests, immunization verifications, Personality Inventories, valid CA drivers' licenses, etc. Please be advised that if a student is unable to be placed at an agency due to issues with any of the above or similar issues, the student may not be able to start/continue with the MSW program.
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Not having a car available to you will limit the availability of field placements.
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Full Name AND Date
Submit and Pay