Human Services Program Application
Woodring College of Education

Department of Health and Community Studies MS 9091
#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:
For Distance Learning and Everett: 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 your 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.
You have completed the three writing prompts in Section 5, double spaced, with your name and the
prompt you are responding to clearly displayed. Please save all three writing prompts in one
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:
ONCE ACCEPTED TO THE PROGRAM: Read the instructions and initiate the Criminal
Background Disclosure at (Do not initiate this background at this time -
wait until you are accepted into the program)
Please note that applying to the program does not guarantee admission. All students are responsible for completing their GURs if entering the program without a DTA or completed General University Requirements 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:
Home Phone: Mobile Phone:
WWU Email (if known): Personal Email:
Optional: Preferred Pronouns:
Location to which you are applying (check one)
Bellingham Distance-Learning Everett
Quarter you wish to begin (check one):
FALL: March 1 application due date. Bellingham, Distance-Learning, and Everett Admissions
WINTER: August 15 application due date. Bellingham Program Admission Only
Returning students: Apply any quarter.
Fall Winter Spring
  Please contact staff at your campus location
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
What is your Academic Level?
Undergraduate Returning WWU Student Completed/Completing AA or DTA
I have completed my GURs through WWU or by completing my DTA
I have
credits remaining to complete my DTA
I 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 felony convictions. I acknowledge I may be denied admission or removed from the Human Services Program if I have plead guilty or received a felony conviction against children or other persons as outlined by RCW 43.43.830- 43.43.845. I also understand that I may be limited in terms of my field placements if I have been charged or convicted of other felonies; if admitted to the program, I agree to discuss any charges or convictions with the Department Chair, the site's Program Director, and the University Instructor who will be overseeing the placement. I understand that nondisclosure of a pending felony 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. 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 for six years and then destroyed. We will provide you with additional instructions regarding how and when to initiate the background check at a later date.
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 and may result in delay of academic progress and involve additional expense; readmission is not guaranteed. Questions should be directed to the Department Manager at (360) 650-7644.
Please complete ALL parts of this section.
Last Name: First Name: MI:
WWU ID if known:            
First quarter of planned program enrollment (check one)
Fall Winter
Site you are applying to:
Bellingham Distance-Learning Everett
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.
Yes No Have you ever been ...
... found in any dependency action under RCW 13.34.040 to have sexually assaulted or
exploited any minor or to have physically abused any minor?
...found by a court in a domestic relations proceeding under Title 26 RCW to have sexually
abused or exploited any minor or to have physically abused any minor?
... found in any disciplinary board final decision to have sexually or physically abused
or exploited any minor or developmentally disabled person or have abused or financially
exploited a others adult?
... found by a court in a protection proceeding under chapter 74.34 RCW, to have abused
or financially exploited a others adult?
... convicted of any crime against children or other persons?
... convicted of crimes related to drugs as defined in RCW 43.43.830?
... convicted of any type of crime other than minor parking/speeding traffic offenses?
... Are you currently charged or under investigation for any of the above?
... Are you currently on any kind of probation?
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 Cooperating Facilities considering providing internship/practice experience/practicum opportunities to me. Upon such request, I will provide my own copy. I also grant Western permission to release my results to the Cooperating Facility upon request. I hereby release Western from any liability or damage that may occur from sharing my results with the Cooperating Facility. 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 - Technology Self-Assessment
Human Services professionals use computer technology to manage information in a variety of ways. Students in the Human Services program must have access to the internet and experience with basic computer software and related technology (for example, MS Word/PowerPoint, email software, etc.).
Yes No
  I have access to the internet and am able to participate in online coursework, including online
discussion boards and submitting appropriately formatted assignments.
Applicant Electronic Signature: WWU ID# (if known):
Section 5 - 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 6 - Submitting Your Application
Please attach the document with your completed essays and the document with a copy of all of your unofficial transcripts (for current WWU students, attach a copy of your Degree Evaluation). 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.