College of Graduate and Postdoctoral Studies 
		GSR 100.1 
	Application for Special Case Admission		
		
INSTRUCTIONS
1.	Type or print legibly in ink.
2.	Arrange to have all official or original transcripts and confidential letters forwarded directly to the Head of the Department in which you wish to study.
3.	A $90 non-refundable application fee must be submitted with your application. (A money order in Canadian funds only, made payable to the University of Saskatchewan).

Mark One	

Mr.	
	
Ms	

Mrs.	
	
Miss	

Dr.	

	

	Family, Surname, Last Name	Given First Name	
Preferred Address:	

	

	

	

	
	
City	
Country	
Postal Code	

Secondary Address:	

	

	

	

	
	
City	
Country	
Postal Code	

Phone Number	

	

	

	

Email	

	

	

	

Date of Birth	
	
Birthplace	

	
Month	
Day	
Year	

	Town, Province, Country	

CITIZENSHIP STATUS (Indicate one)

Canadian Citizen	

	International Applicant		

Permanent Resident
 Date of Landing	
	
 A copy of Permanent Resident card or Citizenship card must be attached to admission	

	
Month	
Day	
Year	

	

It is your choice to self-identify if you belong to one or more of the following minority groups that have been designated by the University’s equity policy	

Aboriginal	
	
Disabled	
	
Visible Minority	
	
Woman	

NOTE:  If you are a Full time Employee of the University of the University of SK, and intend to remain an employee during your program, a memo from your immediate supervisor must accompany the admission	

	

Have you attended the University of Saskatchewan?        	
	
Yes	
	
No	
If YES, in what year did you last Register?	

	

All Previous and Current University Level of Study	
UofS Student Number	

	
PERIOD OF STUDY	
INSTITUTION/ORGANIZATION	
	
GRADUATED	
Office
Use Only	

From	
To	
Name of Institution	
Discipline	
Degree	
Year	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	
Academic awards and distinctions	

	

Degree for which you wish to become a candidate	
	
Field of Study	

	

LETTERS OF RECOMMENDATION	
Give the names and addresses of three persons whom you are asking to submit a confidential letter of recommendation.  Two of them must be persons under whom you have studied. The third may be a person whom you have worked professionally under or under whom you have studied.

	
Name	
	
Position	

	
Address	

	

	
Name	
	
Position	

	
Address	

	

	
Name	
	
Position	

	
Address	

	

Do you currently hold a scholarship or assistantship that will finance your first year of graduate study?	
	
Yes	
	
No	

If not, is attendance contingent on the award of a scholarship or assistantship providing full support?	
	
Yes	
	
No	

Have you been required to withdraw from a program at any educational institution?	
	
Yes	
	
No	

If yes, state the date, name and location of the institution	

	
If yes, do you wish to comment?	

	

Declaration			
I agree, if admitted to the University of Saskatchewan, to comply with the regulations of the University.  I certify that the particulars furnished on the application are true and complete in all respects and that no relevant information has been withheld.  I understand that misrepresentation, falsification of documents or withholding of requested information in regard to this application are serious offenses which may result in dismissal from the university and/or prosecution under the University’s Discipline Regulations and/or the Criminal Code of Canada.	

Date	

Signature of Applicant