Rev 8.1.2014 Counseling Psychology Emphasis*

Rev 8.1.2014 Counseling Psychology Emphasis*

Application for Admission

(Please Type)

First Name / Middle / Last Name
Street Address / City / State
Home / Work / Email: / <>

Name:

Address:

Phone:

Educational History (use additional pages if necessary):

DEGREE MAJOR INSTITUTION DATE

example: B.S. / example: Psychology / example / MM/DD/YEAR
example: B.S. / example: Psychology / example / MM/DD/YEAR
example: B.S. / example: Psychology / example / MM/DD/YEAR

Twelve (12) completed semester hours of psychology coursework (students lacking prereqs will be given one-year to complete).

COURSE TITLE GRADE COURSE TITLE GRADE

Theories of Personality / <A> / Abnormal Psychology / <A>
Psychological Statistics / <A> / <A>
Research Design / <A> / <A>

Graduate Record Examination (GRE) Scores: Verbal <XXX> Quantitative <XXX> Total <XXXX>

Undergraduate GPA <x.xx> Graduate GPA (if applicable) <x.xx>

Major GPA <x.xx> Last Two Year GPA <x.xx>

Three letters of recommendation from former professors or individuals otherwise qualified to comment on your academic performance and potential for doctoral study.

Name Position

example: Dr. Joe Doe / example: Associate Professor of Psychology
example: Dr. Joe Doe / example: Associate Professor of Psychology
example: Dr. Joe Doe / example: Associate Professor of Psychology

Please attach: Essay – Statement of Career Path and Aspirations – a 500-word essay focusing on your career aspirations as a counseling psychologist and research interests. This may include: a) significant people or events that have led you to pursue a career in psychology, b) strengthens and limitations and c) impact you would like to make (for others, the field, etc)

* The Counseling Psychology Emphasis began in 2008 and is not accredited by the American Psychological Association (APA). Accreditation by APA will be sought within the next year .

Signature of Applicant Date

Send application materials to

Counseling Psychology Director of Training

University of Central Arkansas, 201 Donaghey Ave., UCA Box 4915,

Conway, Arkansas 72035-0001

DEADLINE for fall admission: January 15