Human Services Program Application

	Human Services Program Application Woodring College of Education Department of Health and Community Studies MS 9091 HSP.INFO@wwu.edu	#New Form

You will not be able to edit or retrieve this application once it is sent, so please make sure you have completed and attached your writing prompts and ALL unofficial college transcripts.

Application Checklist

Use this checklist to assure submission of a complete application. An incomplete application may delay the review process. It is your responsibility to assure you are submitting a complete application.

You are a WWU student or have applied to WWU: https://admissions.wwu.edu/apply.
For Distance Learning: select: "Location Programs"

You have completed your General University Requirements (GURs) by attending WWU or earning
a Washington State Community College DTA OR You will have 10 or less GUR credits to complete
at WWU after the first day of the quarter for which you are applying OR You will have 5 credits or
less to complete your DTA by the first day of the quarter for which you are applying. Current WWU
students please include a copy of your most current Degree Evaluation (available on Web4u).

You have a cumulative GPA of 2.75 or higher on college level work.
GPAs lower than 2.75 may be considered on a case by case basis
(essay responses are taken into consideration as part of the application process).

You have completed the three writing prompts in Section 4, double spaced, with your name and the
prompt you are responding to clearly displayed. Please save all three writing prompts in one
document.

Essay, up to 500 words

Human Service Experience/Interest Summary, up to 250 words

Social Justice Summary, up to 250 words

You have attached copies of all UNOFFICIAL college transcripts.

You have read, completed, and electronically signed each section in this application:

Please note that applying to the program does not guarantee admission. All students are responsible for completing their General University Requirements (GURs) if entering the program without a DTA or completed GURs from WWU or another university/college.

Section 1 - Personal & College Information

Last Name:

First Name:

MI:

Preferred First Name:

WWU Student ID# (if known):

Mailing Address:

City/State/Zip:

Home Phone:

Mobile Phone:

WWU Email (if known):

Personal Email:

Optional: Preferred Pronouns:

Location to which you are applying (check one)

Bellingham

Distance-Learning

Quarter you wish to begin (check one):

FALL: March 1 priority application due date. Bellingham, Distance-Learning

WINTER: September 15 priority application due date. Bellingham Program Admission Only

Returning Human Service students: Apply any quarter.

Fall

Winter

Spring

Please contact staff at your campus location:
HS.BELLINGHAM@WWU.EDU
HS.DISTANCE@WWU.EDU

What is your WWU enrollment status?

Current WWU Student

Applying to WWU*

*If not currently a WWU student, you must apply directly to the university, using a separate application
https://admissions.wwu.edu/apply

Applications will still be considered after the deadline until program spots are filled for each program.

What is your Application Status?

WWU Undergraduate

Returning WWU Student

Completed/Completing AA or DTA

I have completed my GURs through WWU or by completing my DTA

I will have

credits remaining to complete my DTA

I will have

credits remaining to complete my GURs at WWU

COLLEGE INFORMATION: Please submit UNOFFICIAL transcripts for all college credit received, including Running Start, College in the High School, etc... List those colleges below:

Name of College	Dates Attended	Degree earned	Month/Year Completed

Section 2 - Expectations for Academic and Professional Performance

The Human Services Program at Western Washington University is a professional education program that has standards and expectations for student performance that are differentiated from traditional academic programs. All Human Services Program students are required to meet academic and professional standards and meet essential functions of performance. Applicants to the program are required to sign and submit the following statement indicating that they have read and understand the academic and professional requirements that they must follow if they enroll in the Human Services Program.

I have applied for admission to the Human Services Program at Western Washington University. I understand that I may be denied admission or removed from the program if I fail to abide by ethical and behavioral expectations as outlined by NOHS/CSHSE and/or by the Student Rights and Responsibilities Code at Western Washington University. Departmental decisions may be appealed by students as outlined in the University Bulletin.

I understand that I must complete a Criminal History Background Check and must disclose any pending criminal charges or previous convictions. I understand the Human Services Program has the right to deny entry into the program for applicants who have pled guilty or who have been convicted of an offense under the Revised Code of Washington (RCW) 43.43.830-43.43.845. I acknowledge I may be denied admission or removed from the Human Services Program if I have pleaded guilty or received a conviction against children or other persons as outlined by RCW.43.43.830-43.43.845. I understand that I may be limited in terms of my field (internship) placements if I have been charged or convicted of other felonies. Upon admission to the program, I agree to discuss any charges or convictions with the Department Chair and/or the HS Academic Program Director and/or and the University Instructor who will be overseeing the placement. I understand that nondisclosure of a pending criminal investigation, charge, or conviction during the admissions process or after entering the program is grounds for automatic dismissal.

I understand that if I require and am eligible for reasonable accommodations from the University, I will request accommodations promptly and understand that the Disability Access Center will serve as my point of contact for these requests.

I agree to abide by the above policies and certify, to the best of my knowledge, that all statements contained in this application are true and accurate.


Name/Electronic Signature for submission of application

Section 3 - Criminal Conviction Disclosure

To help determine the ability of each applicant to fulfill the professional requirements of the program, ensure that each prospective student has an appropriate field experience placement, and to provide a safe environment for members in the placement setting as well as students, faculty, and staff of Western Washington University, the Department of Health and Community Studies has established a procedure to conduct criminal background investigations.

This completed disclosure statement must be submitted at the time of application to the program as instructed below. By signing this form, you also agree to initiate an online background check according to instructions that will be provided later to applicants by the Department Manager. Furthermore, you authorize us to review the results of your background check and agree to facilitate the collection of information we deem necessary, including that from law enforcement agencies in any country province or state. This information is kept CONFIDENTIAL.

Failure to initiate the background check as instructed will result in denial/being dropped from the program. Denied/dropped applicants must reapply to the program which may result in delay of academic progress and involve additional expenses; readmission is not guaranteed. Questions should be directed to the Department Manager at 'HSP.Info@wwu.edu

Instructions:

Please complete ALL parts of this section.

Last Name:

First Name:

MI:

First quarter of planned program enrollment (check one)

Fall

Winter

Year:

Site you are applying to:

Bellingham

Distance-Learning

Part I:

Check the box to the left of each statement or question that is either true or that you would respond to with a "Yes". Checking a box may not automatically disqualify you from consideration for the program.

Part II:

For all questions checked YES in Section I, specify BELOW the kind of offense, any conviction or action, date(s), sentence(s), or penalty imposed, prison release date(s) and current standing (e.g. parole, probation, or work release). Attach another sheet if necessary.

Part III:

I understand that upon acceptance to the program, I and/or Western may be required to share my background check results with community based organizations considering providing internship/practice experience opportunities. I also grant Western permission to release my results to the organizations upon request. I hereby release Western from any liability or damage that may occur from sharing my results with the organizations. I certify under penalty of perjury of the laws of the State of Washington that the information I have provided is correct and true.

Applicant Electronic Signature:

Date:

Section 4 - Writing Prompts

The following three writing prompts tell us who you are and what inspires your choice to be a Human Services professional. Essays are reviewed for both substance and quality of writing. The document should be double spaced with your name and the prompt you are responding to clearly displayed. Please save all essays in one document.

The writing prompts below are designed to engage you in considering ideas associated with the Woodring Vision, which charges faculty and staff with fostering community relationships and a culture of learning that advance knowledge, honor diversities, and promote social justice.

	Prompt #1:	Essay, up to 500 words: Respond to the following question: What leads you to believe that you are well suited to be a Human Services Professional and that Human Services is the right academic major for you?

	Prompt #2:	Human Service Experience/Interest Summary, up to 250 words: Summarize up to three of the most meaningful human services-related experiences you have had, which have influenced your decision to enter the field. This may include providing services such as paid work, volunteer efforts or academic work; or being on the receiving end of human services interventions/programs.

	Prompt #3:	Social Justice Summary, up to 250 words: Summarize any personal experiences, skills, or characteristics that support your ability to work with traditionally marginalized populations.

Section 5 - Submitting Your Application
Please attach the document with your completed essays and the document with a copy of all of your unofficial transcripts. To add attachments: Click the "Add Attachment" button below and follow the directions on that screen for each document. After you have attached the documents, use the "Submit" button below to submit your application.

If the application due date falls on a weekend or holiday, the application will be due the next business day.

Signatures and Attachments

The submitter may optionally enter their email address below. Press SUBMIT to send it.

Your Email Address: