APPLICATION FOR ADMISSION TO THE - Western Michigan …



Application for Admission to thePh.D. Program in Counseling PsychologyWestern Michigan UniversityAPA-Accredited Materials required by the Graduate College admissions office are:1. Online Graduate College Application for admission and application fee.3. Graduate Record Examination scores, including GRE Psychology score if applying on the basis of a bachelor’s degree. Please note that GRE scores must be no older than 5 years.2. Official transcripts Send these materials to:Admissions and Orientation Office1903 West Michigan Ave.Western Michigan UniversityKalamazoo, MI 49008-5211269-387-2000Materials required by the Department include:1. This application2. Three (3) current letters of recommendation 3. A current resume or vita4. An autobiography which includes a clear and complete statement of the development of the applicant’s professional goals and how the applicant relates those goals to doctoral studies in Counseling Psychology.Send these materials to:Department of Counselor Education and Counseling Psychology 1903 West Michigan Ave.Western Michigan University Kalamazoo, MI 49008-5226 269-387-5100 All the above materials must be received by December 10. If December 10 falls on a weekend or holiday, all application materials must be received by the next business day. We recommend that you allow a minimum of?two weeks for your materials to arrive by the deadline date. Fields will expand as you typeDate: FORMTEXT ?????mm/dd/yyyName: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????LastFirstMiddleFormer name, if applicableSocial Security number: FORMTEXT ???? ?Current Mailing Address: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Number & StreetCityState, Zip CodePermanent Address: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Number & StreetCityState, Zip CodePhone (primary): FORMTEXT ?(???) ?Type (cell, home, work, etc.): FORMTEXT ???? Phone (secondary): FORMTEXT ?(???) ?Type (cell, home, work, etc.): FORMTEXT ???? Email Address: FORMTEXT ???? ?Please be sure to provide an address that you access regularlyUndergraduate and Graduate Education: FORMTEXT ? ?? ?? FORMTEXT ? ??? FORMTEXT mm/yyyy-mm/yyyy Institution City, State Dates of Attendance FORMTEXT ? ? FORMTEXT ? ?? FORMTEXT ? FORMTEXT ? FORMTEXT ? Degree/Major Psychology/Counseling GPA Cumulative GPA Credit hoursCredit hours FORMTEXT ? ?? ?? FORMTEXT ? ??? FORMTEXT mm/yyyy-mm/yyyy Institution City, State Dates of Attendance FORMTEXT ? ? FORMTEXT ? ?? FORMTEXT ? FORMTEXT ? FORMTEXT ? Degree/Major Psychology/Counseling GPA Cumulative GPA Credit hoursCredit hours FORMTEXT ? ?? ?? FORMTEXT ? ??? FORMTEXT mm/yyyy-mm/yyyy Institution City, State Dates of Attendance FORMTEXT ? ? FORMTEXT ? ?? FORMTEXT ? FORMTEXT ? FORMTEXT ? Degree/Major Psychology/Counseling GPA Cumulative GPA Credit hoursCredit hours FORMTEXT ? ?? ?? FORMTEXT ? ??? FORMTEXT mm/yyyy-mm/yyyy Institution City, State Dates of Attendance FORMTEXT ? ? FORMTEXT ? ?? FORMTEXT ? FORMTEXT ? FORMTEXT ? Degree/Major Psychology/Counseling GPA Cumulative GPA Credit hoursCredit hoursII.Relevant Professional Experience:Position Description of DutiesLocationDates From To FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????III.Relevant Volunteer, Practica, and /or Internship Experience:Position Description of DutiesLocationDates From To FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????IV.List any honors, prizes, distinctions, scholarships, fellowships, publications, and professional association memberships: FORMTEXT ?????V. Write a brief description of your professional goals. Please indicate some discussion of your desired work setting and duties associated with your particular role: FORMTEXT ?????VI. If admitted: A. I realize that the program prefers full-time continuous enrollment in at least 9 or more graduate hours per fall and spring semester. Select one: FORMCHECKBOX Yes FORMCHECKBOX No B. I FORMCHECKBOX will FORMCHECKBOX will not need financial assistance and / or part-time employment during the residency period. I FORMCHECKBOX have FORMCHECKBOX have not submitted an application for financial assistance to The Graduate College. I FORMCHECKBOX have FORMCHECKBOX have not submitted an application for an assistantship/associateship to The Graduate College. C. I realize the program requires completion of a 2000 clock hour predoctoral internship at an APA approved site. This may require a geographical move. Select one: FORMCHECKBOX Yes FORMCHECKBOX No Acknowledgment:I am aware that application to the Department of Counselor Education and Counseling Psychology’s Graduate Degree Programs is a competitive process and that meeting minimum Graduate College requirements does not guarantee admission. I understand that if I have been convicted of a felony or misdemeanor, this may make it difficult to obtain required external agency training experiences, i.e. field practicum, internship; and if unable to obtain these required experiences, I will not be able to complete my program of study and graduate. I am further aware that if I have been convicted of a felony or misdemeanor, I may not be eligible for licensure or certification by the State of Michigan or by other jurisdictions. The Michigan Board of Counseling and the Michigan Board of Psychology have indicated on their web pages that applicants who have been convicted of a felony or misdemeanor will be “reviewed on an individual basis,” and that they "take into consideration the type of conviction, the age that you were when the incident occurred and the time that has elapsed since the conviction." (Retrieved September 9, 2006 from)I am aware that questions concerning eventual eligibility for professional licensure should be directed to the appropriate professional licensing board in the relevant jurisdiction. Professional licensing laws and regulations vary from state to state. I am also aware that students admitted to or taking courses in the Department are expected to abide by the ethical standards of the professional association relevant to their program of study.Signature: _________________________________________________Printed name: ______________________________________________Date: FORMTEXT ?????mm/dd/yyy ................
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