First Name *

Middle Initial *

Last Name *

Mailing Address *

City *

State *

Zip/Postal Code *

Country *

Preferred phone number *

Preferred email *

Date of Birth *

College now attending/last attended *

Previous degree *

Major *

Have you previously attended Lewis & Clark? *

Under which name?

Do you currently hold a counseling, teaching, or administrative license? *
yes
no

Planned Program of Study

Planned term of enrollment

ACADEMIC PROGRAM - please choose one or more of the following

Addiction Studies

Community Counseling

Educational Leadership

Marriage, Couple, and Family Therapy

Psychological and Cultural Studies

School Counseling

School Psychology

Teacher Education: Preservice program
(For students who do not hold a teaching license and are new to the field. Summer start only.)

Master of Arts in Teaching with Initial Teaching License:

Teacher Education: Inservice program
(Advanced preparation for students who may have licensed teaching experience.)

How did you hear about Lewis & Clark Graduate School?

Comments