Prospective Students

Current Students

Eastern Illinois University
600 Lincoln Avenue
Charleston, IL 61920
Phone: (217) 581-2400
Fax: (217) 581-7800
Email: csd@eiu.edu

Name * First Last
Today's Date * / MM / DD YYYY
Current Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home/Cell Phone * - (###) - ### ####
Work Phone - (###) - ### ####
Fax - (###) - ### ####
Email *
Date Baccalaureate Degree Received * / MM / DD YYYY
Major *
Institution *
Applying to Begin in: * Fall Spring Summer
Of What Year? *
Please Select Interview Location * CSA Days (Eastern Illinois University) Oshkosh Placement Exchange Southern Placement Exchange Interview (Housing Recruitment)
References: List two persons who will be completing the Admissions Recommendation Form.
Name of Reference #1 * First Last
Job Title of Reference #1 *
Address of Reference #1 *
Phone Number of Reference #1 * - (###) - ### ####
Name of Reference #2 * First Last
Job Title of Reference #2 *
Address of Reference #2 *
Phone Number of Reference #2 * - (###) - ### ####
Additional Attachments
Please attach a letter of intent focusing on your interest in the department and program. *
Please attach a résumé of your past work experience(s), organizational involvement, leadership role(s), etc. *