The University of Southern Mississippi
School of Library and Information Science
Prospective Student Questionnaire and APPLICATION


So that we may know more about you (and your interest in an assistantship) during the application process and analyze
the demographics of prospective students, we request that you print out this questionnaire and send (or FAX) it to us.

The University of Southern Mississippi
School of Library and Information Science
118 College Drive #5146
Hattiesburg, MS 39406-0001		  
Tel: (601) 266-4228
Fax: (601) 266-5774
URL: http://www.usm.edu/slis/
E-mail: slis@usm.edu


Last name:  _______________________________________

First/Middle name:__________________________________

SSN (optional): ____________________________________

Anticipated start date:

Fall
Spring
Summer

Year:____________


Date: _____________________ Work phone: _________________ Home phone: __________________

E-mail:  _________________________________________________________________________________


Mailing Address: ________________________________________________________________________

_______________________________________________________________________________________


Occupation/Title:__________________________________________________________________________

Place of employment: ______________________________________________________________________

I plan to attend full time; part time; face to face; completely online.

I plan to work in the following:

Academic library Public library School/Media Center
Corporate or governmental library/information center
Other _______________________________ Undecided

My interests include:

Adult services Archives and special collections
Administration Children's/Young Adult literature/services
Information Science and Automation Non-print media services
Public services (reference, circulation, etc.)
Technical services (cataloging, acquisitions, etc.)
History of libraries, books, and other media
Information policy Other ________________________________

I plan to seek the following program:

Non-degree teaching licensure program on undergraduate level
Bachelor of Arts with K-12 licensure
Bachelor of Arts (non-teaching degree)
Non-degree teaching licensure program on graduate level
Master of Library and Information Science with K-12 licensure
Master of Library and Information Science
Dual master's with LIS and History
Dual master's with LIS and Anthropology
Dual master's with LIS and Political Science
Specialist in Library and Information Science
Specialist in Library and Information Science with K-12 licensure

Are you seeking financial assistance from the University? Yes No

SLIS offers assistantships to a limited number of full-time students each year on a competitive
basis. Student Assistants work 20 hours each week (at a modest hourly wage)
and receive a full tuition waiver. Do you wish to be considered for such assistantships?
Yes No
If "Yes," please briefly describe your potential interests and skills and attach to your resume. Include statements
about your skills with software/hardware, office equipment, the internet (including web design),
bibliographic searching, graphic design, foreign languages, or research design.

EMPLOYMENT HISTORY AND GOALS

The following items must be submitted to the School of Library and Information Science in order
for your application to be considered:

1. Resume. Please include all work experience, including present employment.
2. Formal Letter of Application. Please include a description of your interests in library and
information science, future plans or aspirations, and any other information you think would be
pertinent to your application. This should be no less than 1000 words.

Thank you.

AA/EOE/ADAI
Modified July 28, 2005