Program Application

NAME *

Date of Birth *

PERMANENT ADDRESS *

WORK ADDRESS

CURRENT POSITION

HOME TELEPHONE NUMBER *

WORK TELEPHONE NUMBER

FAX NUMBER

E-MAIL *

EDUCATIONAL DATA:

List Name of College, Date Attended, Major, Degree Granted and Date *

Grade Point Average Overall *

Grade Point Average in Undergraduate Major *

RELEVANT WORK EXPERIENCE/EMPLOYMENT *

OTHER RELATED EXPERIENCE, e.g. volunteer work, organizations, etc *

INTERESTS/HOBBIES *

HONORS/AWARDS *

Undergraduate Prerequisites *

Abnormal Psychology

Developmental Psychology

Statistics

Abnormal Psychology - Semester/Year Taken - Grade Earned

Developmental Psychology - Semester/Year Taken - Grade Earned

Statistics - Semester/Year Taken - Grade Earned

How do you plan to do your work, if admitted to the program? Minimum time for completing the program including the intership is eight semesters (two summer semesters). *

When do you plan to begin your work if accepted? (Month & Year) *

When do you hope to complete your work? (Month & Year) *

Statement of Intent: Provide a typed, 2-3 page, double-spaced statement that addresses the following:

Your professional goals.
Why you are pursuing training in School Psychology rather than in other mental health disciplines (e.g. school counseling, clinical psychology, marriage and family counseling).
Considering your total application, what are your major strengths and weaknesses with respect to the School Psychology program.
Please address any elements of your application that do not meet the preferred criteria (e.g., GRE score, grade point average, etc.)

Your Statement of Intent will be evaluated for content, style, and quality.

Statement *

COLLEGE OF EDUCATION

Dept of Counseling, Leadership, Adult Education & School Psychology

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Program Application