ILLINOIS STATE UNIVERSITYDEPARTMENT OF PSYCHOLOGY

GRADUATE STUDENT DATA SHEET for Master’s and Specialist Degree Programs

Note: Please keyboard entries directly into the shaded areas of this form, check the appropriate boxes, and select the appropriate items from pull-down menus. The shaded areas will expand as necessary when you keyboard data in them and the “enter” key will create a new line. Also, use the TAB key to move from one field to the next. The form may be saved and edited later, but you will need to print the form, sign and date it, and submit the hard copy. Electronic submission is not available this time

Prospective students, applying for admission to the Clinical-Counseling Psychology Program, are required to have 15 hours of undergraduate classes in Psychology, which include introductory psychology or an equivalent course, social science statistics or equivalent, research design or equivalent, and a learning theory course or equivalent.

Students, applying for admission to the School Psychology Programs and the Psychology Program (with sequences in Cognitive and Behavioral Sciences, Developmental Psychology, Industrial/Organizational-Social Psychology, and Quantitative Psychology) are required to have completed a minimum of 21 semester hours in undergraduate psychology coursework that includes introductory psychology or an equivalent course, statistics or equivalent, and research design or equivalent course.

A requirement of finite mathematics or precalculus will be waived for an applicant if a grade of "B" or above in a college-level statistics course has been achieved or a score of 500 or greater is attained on the Quantitative section of the Graduate Record Examination (GRE). Students who have not completed this coursework may be admitted but will have these courses added to the graduate degree program requirements.

If you desire a departmental graduate assistantship or tuition waiver (you may apply simultaneously to both), you are required to include the appropriate Graduate Assistantship/Trustee’s Tuition Waiver form found at This form must include the Selective Service Statement (third page) and the required signatures and dates.

Name:
(Legal Last, First and Middle Names) / Date:
Email Address: / UID No.:
(University Identification No., if current ISU student)
Permanent Address/Phone Number / Present Address/Phone Number / Address/Phone Number where you can be reached UNTIL June 1
University presently attending / Other universities attended(list institution name, address, attendance dates, semester hours earned, degree conferred and year)
Based on a 4-point scale, please indicate the following grade point averages
(using grades from all college courses from all community colleges, colleges and universities you have ever attended):
Cumulative / Last 60hours / Psychology Coursework
Hours earned beyond
highest degree: / Undergraduate Major
Minor
Complete this statement with the pull-down menus: “I am applying for admissions for the…”
Fall Semester of (choose one)200720082009as a(choose one)full-time student in the area of(choose one)Cognitive & Behavioral Science (0801)Developmental Psychology (0807)Industrial/Organizational-Social Psychology (0802)Quantitative Psychology (0804)Clinical-Counseling Psychology (0180)School Psychology Specialist (9300) .
Identify faculty members who share your interests or with whom you would like to work. Faculty interests may be viewed at
Identify your computer and statistical skills by package(s) (check all that apply and provide further detail below).
Basic Software / Statistical Packages / Other
Spreadsheet / SPSS / Psychlit
Database / SAS / Grade Book
Word Processing / Other () / Mallard
Please comment on the extent of your computer programming experience or software knowledge or hardware installation:
How did you hear about our graduate program (check all that apply):
APA Guide / Faculty Advisor / Flyer/Bulletin
GradSchools.com / Friend/Former Student / Currently an IL State Univ Undergrad
Internet / Other () / I am IL State Univ Alumni

In this area, list the titles of all psychology courses you have completed (or plan to complete prior to pending graduation), the hours of credit, and the grade received (you may not substitute a copy of your transcript). Use a separate line for each course.

In this area, please list your academic honors and awards.
In this area, list your professional experiences (paid, unpaid, volunteer, undergraduate internships, etc.) relevant to your application (include dates, employer, location, and nature of position).
In this area, list your research experiences and skills (including statistics and computing skills)
In this area, describe what there was about the Illinois State University graduate program that led to your decision to apply here.
In this area, describe your career and professional goals.
In this area, describe why the Department of Psychology should admit you to a particular graduate program/sequence and/or award you an assistantship, tuition waiver, or fellowship. (The typing area will expand as needed.)

If you are applying for a tuition waiver, provide the information requested below:

Note: Financial need information should pertain to the semester for which a waiver is requested.

Do you claim Illinois residency:.

Highest degree earned (as of upcoming fall admission date):.

If employed, does your employer reimburse you for tuition costs:.

If yes, what percentage:

How many hours/week are you employed (anticipate being employed):

Financial support received from parents/other relatives/friends?.

Comments:

Dependants: Spouse Children (No of Children: ) Other (specify):

Is spouse employed:.

Other forms of financial aid received (during the applicable semester)?.

If yes, identify type (e.g., scholarships, fellowships, loans):

Each applicant may check to see if their application is complete (no more than once a week) by an e-mail to .

Your required signature here certifies all information above is true, complete and accurate.
Applicant’s Signature: ______Date: ______

(rev 9/06)