Tell us about yourself First Name * Last Name * Email Address * Preferred Phone Type * Please select... Home Cell Work Home Phone * Cell Phone * May we contact you via text message? Yes No Work Phone Best Time to Call Please select... 8:00 am - 10:00 am 10:00 am - 12:00 pm 12:00 pm - 2:00 pm 2:00 pm - 4:00 pm 4:00 pm - 6:00 pm After 6:00 pm Address * Include PO Box or apartment number City * State/Province Please select... ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FED STATES OF MICRONESIA FLORIDA GEORGIA GUAM GU HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA N. MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Zip or Postal Code * How did you hear about Concordia? Please select... COE Reply Card Concordia Direct Mail Fair - Local/Private Open House/Info Event Oregonian Personal Call Personal Email/Letter Radio Advertisement Refer by Alumni Refer by Congregation Refer by Employer Refer by Friend Web Search Anticipated Start Term Please select... Spring 2015 Summer 2015 Fall 2015 Spring 2016 I am Interested in: Please select... Master of Business Administration Graduate Education Programs (MED) Master of Arts in Teaching (MAT) MA in Teaching English as a Second Language MA in International Development and Service Master of Arts in Psychology: Community Psychology Doctor of Education Please select... MAT Elementary (Pre K-8th) MAT Secondary (Middle & High School)Full-time, 11 month program, starts every January and June. Part-time evening, 22 month program, starts every August Graduate Education Programs Please select... I would like to become a licensed teacher I currently hold a teaching license and want to pursue a master's degree I currently hold a teaching license and want to to pursue an authorization level I currently hold a teaching license and want to pursue additional licensure I have a teaching license and would like to add an endorsement I am interested in Concordia's Career and Technical Education Program I am interested in Concordia's M.Ed. in Leadership Program (non-licensure)Master of Education, license, endorsement, and authorization level options begin every semester Schedule PreferencePlease select... Evening Weekend Master of Arts in TeachingPlease select... Elementary (Pre K - 8th Grade) Secondary (Middle & High School) Master of EducationPlease select... Master of Education in Administration (Initial Admin License) Master of Education in Curriculum and Instruction Master of Education in Educational Leadership Master of Education in Special Education (Elementary) Master of Education in Special Education (Secondary) Additional LicensurePlease select... Continuing Teaching License Continuing Administrator License Initial Administrator License I would like to add an authorization levelPlease select... Elementary High School I would like to add an endorsementPlease select... Early Childhood Education English to Speakers of Other Languages Health & Physical Education Reading Specialist Special Education (Elementary) Special Education (Secondary) Doctor of EducationPlease select... Educational Administration Higher Education Teacher Leadership Transformational Leadership Comments/Questions? Questions? Problems with this form? Contact the Office of Admission at 1-800-321-9371 or .