New AGS Student – Adizes

New AGS Student

APPLICATION FOR ADMISSION

Name:

Title:

Address:

City/Zip Code:

Country:

Best Phone & Country Code:

 

 

Alternate Phone & Country Code:

 

PRIMARY Email:

 

 

Alternate Email:

 

 

PHOTO ID Type: Number: Exp:

Checklist for a Complete Application:

Application with Statement of Purpose, Intellectual Property, Ethics, Computer Capabilities

Resume or CV

Two Written References

Transcripts and/or proof of degree

Online courses only: Optional Assistantship Request

Self-Assessment

Overseas students: Proof of English Proficiency is assessed by essay - TOEFL may be required

All documents MUST be emailed to registrar@adizes.comor FAXED to 805-565-0741. Supporting documentation may be emailed or faxed.

I understand it is strongly recommended that I complete the Entrance Exams. I understand that the exam is meant to assist me in identifying important concepts and terminology which will serve as reference material throughout the degree program.

I am applying for a: Certificate CSOMT Certificate SCMT Certificate SBA

M.A.CSOMT M.A.SCMT MA SBA

Ph.D. CSOMT Ph.D. SCMT

Currently not accepting new students for the following programs:

DDT Design DDT Diagnosis DDT Teleology MA OT Ph.D. OT Dual Track MA/PhD (I have 30 units of graduate credit but no Master Degree)

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 2

PERSONAL INTERESTS

(This page may be shared online with students, faculty, prospective students, and on the web, etc.)

Languages (fluent):

Last 2-3 books you have read:

BEST Three books you have read:

Please check areas of special interest to you:

 

 

Philosophy

Psychology

Sociology

Music

Art

Political Science

History

Law

Biology

Physics

Mathematics

Chemistry

Engineering

Zoology

Architecture

Astronomy

Business

Environment

Women’s Studies

Education

Urban Studies

Medicine

Parapsychology

Marketing

Finance

Anthropology

Social Systems

Fiction

Performing Arts

Classic Literature

Software Development

International Relations

Computer Science

Artificial Intelligence

Alternative Medicine

Ethnic & Cultural Studies

Manufacturing

Other Areas:

 

 

Provide information regarding your education (degrees or programs completed: field, institution and date).

OFFICIAL TRANSCRIPTS MUST BE PROVIDED - see policy for details. Initial here
Bachelors or Master Degree: (School, subject, year graduated)

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 3

Instructions for Personal and Professional References

STUDENT NAME:

Directions for Applicant

Please ask your reference to complete this confidential recommendation form and return it to you in a sealed envelope signed across the seal. Provide at least TWO references to AGS along with your completed Application. PROFESSIONAL PROGRAM STUDENTS: One reference MUST be from your Adizes Managing Director

Directions for Reference

The individual whose name appears above is applying for admission to Adizes Graduate School. Your comments about the individual’s initiative, maturity, self-motivation, and intellectual capacities are required in order for AGS to determine the applicant’s suitability for the program to which he/she is applying. Your comments are an important component to the applicant’s admissions packet. Thank you for taking the time to complete this reference.

On the reverse side of this page, please provide the following:

1. How long have you known the candidate?

2. In what capacity have you known the candidate?

3. Please compare the candidate with others you have known during your professional career and indicate your assessment.

Assessment

Please provide a candid assessment of this individual’s potential for success as an independent and active learner in a graduate program of study. Include a description of specific activities or accomplishments that show her/his strengths and weaknesses. Please use a separate sheet(s) if needed to discuss the following points:

Academic/professional preparation

Evidence of scholarly/professional research

Quality of experience or practice, skills

Quality of scholarly/professional writing

Ability to be self-directed, initiative in interaction

Openness to feedback and personal/professional reflection

Ability in theoretical/conceptual and critical thinking

Computer literacy

Overall assessment as a graduate candidate

English proficiency

CONTACT INFORMATION

NAME:

TITLE/EMPLOYER:

ADDRESS:

CITY/STATE/COUNTRY/POSTAL CODE:

EMAIL:

TELEPHONE:

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 4

STATEMENT OF PURPOSE

This information may be summarized and shared. Use more paper if you wish.

EMERGENCY CONTACT (Outside your personal household):
EMAIL: T E L:

ALTERNATE EMAIL:

Address:

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 5

1. ATTACH RESUME OR CV; TRANSCRIPTS; REFERENCES; TOEFL/IELTS; ENROLLMENT AGREEMENT AND ALL RELATED DOCUMENTATION. EMAIL TO YOUR ADVISOR OR FAX YOUR APPLICATION TO 805-565-0741 or 270-626-7243. NO JPG or GIF FILES PLEASE.

There is a $250 late fee for documentation received late and without notice! Many documents can be accepted via email or fax - contact your advisor for details.

2. UPON APPROVAL FOR ADMISSION, ALL FEES will be due.

Non-personal information within this application maybe shared with other students, prospective students, faculty, administration, and with the general public through the AGS E-Newsletter or website. This information may include student’s recommended best books, checked areas of interest, the statement of purpose or a summary of the statement, country of origin and/or residence, degrees held and field of employment. There will be no specific identification of students, residences, university affiliations, clients, references or employers. For examples of summary information, see the AGS website. Individual confidentiality is always maintained. Contact information or other means of identifying an individual are never shared with or provided to organizations or individuals outside of Adizes Graduate School and its direct affiliates. Summary information or documents will be provided to representatives of governing agencies if legally required. The student agrees, however, that papers and dissertation or thesis products may be published via the AGS Newsletter or website. With that acknowledgement, AGS understands that “first” publication in an industry or academic journal may be preferable. INITIALS REQUIRED:

DEGREE PROGRAM PARTICIPATION

I understand that credit earned at the Adizes Graduate School for Transformational Studies will probably not be transferable to any other college or university. If I earn a degree in the Adizes Graduate School Programs, in most cases it will probably not serve as a basis for obtaining a higher level degree at another university as per the disclosure in the Program Catalog (which I have read and understand).

Student Signature

Date

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 6

COMPUTER CAPABILITIES

It is required that you fully complete this section:

 

1. Type of Desktop

Laptop

2. OS Type and version

3. Hard drive size Free space RAM

4.Maximum connection speed and Type (Cable, DSL, 3G, etc.):

5.Internet Service Provider

6.Browser type and version (like Firefox, Internet Explorer):

7.Advise if you have a printer, scanner, fax or other devices:

8.List software you use most frequently (a word processing program is required)

9.Describe any experience with online learning platforms (Blackboard, Moodle, etc.):

WAIVERS AND PERMISSIONS

I waive any right to access the confidential recommendations that may be submitted in support of my application from references or employers that I have pro- vided to AGS (Adizes Graduate School)

If you have a relationship with the Institute, by initialing here, you agree that your grades/academic record may be released to the Institute.

Initials

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 7

INTELLECTUAL PROPERTY STATEMENT

I agree that AGS has the right to edit, publish and disseminate (with full individual credit and recognition) transcriptions of online course dialogue in which I have participated. I further understand that the name and marks of “Adizes” and all copyrighted materials which may be provided to me in the course of study are proprietary and no unauthorized duplication is allowed.

ETHICS STATEMENT

I understand that Adizes Graduate School policies provide for access to faculty through the online environment and that I may take any opportunity to provide feedback regarding course structure, services, policy and administration through the on-line environment.

AGS policy assures flexibility in individual expression in meeting course objectives and has a standard of ethics pertaining to online interaction. These policies state that all students are expected to work on the honor system, to do their own work and act with the highest degree of ethical and professional conduct with regard to their work and their colleagues.

Students may be withdrawn from class at the request of the Instructor in order to maintain the integrity of the class and the graduate program. Students may be withdrawn for not meeting the requirements for participation including attendance, assignments (timeliness) and/or quality of academic contribution, or for academic misconduct. Exceptions may only be granted by written approval from faculty. Appeals may be filed through informal or formal grievance procedures described in the Program Catalog, which I have read and understand.

Any student who is cited for academic misconduct (sexual, verbal, written, or other harassment of faculty, staff or colleagues online or off) may be subject to suspension from the program, and possibly expulsion at the discretion of the CEO of Adizes Graduate School who will seek input from the Academic Dean, Faculty and Administration. Appeals may be filed through the formal grievance procedures described in the Program Catalog, which I have read and understand.

NAME:

Signature

Date

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 8

AUTOBIOGRAPHY and SELF ASSESSMENT INSTRUCTIONS

Attach yourAutobiography and Self-Assessment - REQUIRED FOR ALL NEW STUDENTS Self-Assessment Essay Instructions: Please include ALL of the following brief sections:

A.Explore your scholarly interests and goals and link them with EACH academic course in your Degree Program.

B.Have you been involved in distance work or learning before (describe)?

C.Using the tools provided on the AGS website, identify learning strategies, your strengths and environmental preferences. Discuss your findings in your Self-Assessment essay. (Building Excellence [$5] and Multiple Intelligences [free] are required)

D.Describe your plan to schedule blocks of time for graduate study at home. Note that each course requires a commitment of 10-15 hours per week to excel. This is not a weekend program.

E.Describe the support you have from your family, children, friends, employers, clients, and pets or any significant other in your environment.

F.Please answer one of the following four questions.

1.Describe an ethical dilemma you have experienced firsthand. Discuss how you thought about and managed the situation.

2.In your field of expertise, what are the repercussions of change and how might you manage them?

3.In your experience, is there a colleague who has had a significant influence on your development? How?

4.Describe a significant professional experience in which you had some responsibility. What did you learn from that experience? What was its impact on the development of your theoretical orientation?

G.Is English your second language? If so: If you are not providing TOEFL results, this essay will be reviewed by faculty as a basis for proof of English Proficiency. Contact us if you are unsure whether TOEFL is required in your case. ALL students are required to be proficient in ENGLISH.

I am enclosing TOEFL Test Results: YES NO

My Autobiography is attached: YES

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 9

Professional Programs Only

Return this section only after it is signed by your assigned local Adizes Institute office:

Statement of Internship Approval

I wish to work with Adizes Institute in (country)

Internships provide students with the opportunity to observe and to participate in actual client work through a local Adizes Institute office. The professional programs are highly experiential. The internship is the cornerstone of the program. Successful completion is vital to a student’s success.

Student hereby states: I have discussed the requirements with the local Adizes Institute office Director and understand what will be expected of me during the internship. I have signed an internship agreement with the local office, my Internship Supervisor has been assigned by Adizes Institute and am aware of the local policies, procedures, any payments to be made to me as well as costs that will be incurred by me during this internship.

If I terminate my enrollment in AGS for any reason, I shall return any materials given to me by that office within 10 days following the date of my notice of cancellation. If I fail to return these materials within the 10-day period, AGS may deduct the documented cost for the materials from any refund that may be due to me in order to compensate the local Adizes Institute office.

Agreed to by:

Student Signature Date

Acceptance by Local Adizes Institute Office:

I am aware of all the internship requirements at Adizes Graduate School and will work with the student named above to ensure that all requirements are met in a timely manner. I have been informed of the on-site training program and schedule and a) will ensure that the student has met the pre-internship requirements before the start of that program and b) indicate my understanding that the student will be unavailable for any work through our offices during the dates needed. I understand that a High Pass is required on written exams in Adizes phase trainings to proceed to the next phase. The student has signed our offices’ local agreement for internship and is aware of our local policies and procedures.

Agreed to by:

 

 

 

Signature of Local Adizes Institute Office Director

Date

Director’s Name (please print)


City/Country of Adizes Institute Office

Assigned Internship Supervisor NAME:

 

 

 

 

Supervisor Signature:

Date:

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org

Page 10

REQUEST FOR PARTICIPATION in the ASSISTANTSHIP PROGRAMS

(ONLINE FULL PRICE CLASSES ONLY)

This form must be completed EACH time that assistance with tuition is requested (EACH term). Tuition is $2000 US Dollars per online class. The Assistantship program can provide up to 50% of tuition per online class. No other costs are covered. Assistantships will be provided depending upon the number of requests in ratio to enrollment, individual qualifications, and merit with regard to previous awards if applicable.

I, would like to participate as a Research Assistant.

This is: A work/study program providing faculty with assistance on their research projects, primarily the Academic Dean. This position is intended to provide information for faculty and to assist them in the creation of high quality publishable working papers. Student research will therefore require broad literature review into the focus area, as well as identification and discussion of specific case references. Formal APA style is required including complete citations, abstract and subheadings. Please provide your background, capabilities, and interests (topics) for research.

The Assistantship program privilege that may be revoked if students fail to meet their commitments. All students should own the most up-to-date APA Style manual. Re-admission to the Assistantship program is never guaranteed.

Students/supervisors are required to submit a mid-term report at the six-week mark and have their final project turned in to their supervisor by the end of each term. Students should seek guidance at multiple intervals.

The value of each approved project is set at $1000USD. Full tuition will be due for those who do not complete their project on time. Benefits and amounts due will not be prorated. AGS staff will make every effort to assist you, but students are required to independently manage this work/study project.

REQUIRED: On an attached page provide ALL OF the following.

1.Describe your financial need ~ relevant employment, salary, conversion to USD (Needs assessment):

2.Describe why you believe you would can contribute to a publishable paper with conceptual foundations in Adizes material (skills, affiliations, experiences, special personal interest, and access to special populations):

3.Describe two ideas for potential Research Projects, including the Adizes material you will review in context.

I request funding in the amount of % (percent) of tuition this term.

 

 

 

Signature

Date

Adizes Graduate School • 1212 Mark Avenue • Carpinteria • California • 93013 • USA • Admissions Office: (805) 565-2901 • Fax: (805) 565-0741 • http://www.adizesgraduateschool.org