Supplemental Professional Counseling Program Application
Submit to: College of Graduate Studies, Box 42,
Middle Tennessee State University
Murfreesboro, TN 37132
To which concentration are you applying?
_____Clinical Mental Health Counseling
_____School Counseling
_____School Counseling License
(Adding to Previous Master’s)
Applicant’s Name: ____________________________________________ Preferred Name: ___________________
MTSU ID# (if known):______________________ Date of Application: _____________ Application Term: ___________
Email: ____________________________________________ Telephone #:________________________________
Current Address: _______________________________________________________________________________
City: _____________________________________________ State _________________ Zip code ______________
Permanent Address: ____________________________________________________________________________
City: _____________________________________________ State _________________ Zip code ______________
Education:
Institution
Major
Degree
GPA
Date of Graduation
GRE:
Date taken: ____________ Verbal score: __________ Quantitative score: __________ Writing score: __________
(Writing score not required for admission)
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Name: ______________________________________
Have you ever been convicted of a misdemeanor or felony?
_______Yes
_______ No
_______Yes
_______ No
If yes, please explain:
Do you have a misdemeanor or felony charge pending?
If yes, please explain:
How did you find out about our program?
Technological Competence and Computer Literacy Questionnaire
(please answer “yes” or “no” to the questions below):
Yes
No
1. Do you know how to use a word processing program such as Microsoft Word or Word
Perfect?
If you answered “yes” to question #1, could you do any of the following without seeking help
from another person?
a. type a letter or document?
b. “cut” a paragraph of text and “paste” it into a different part of the letter/document?
c.
d.
e.
f.
insert, say, a 3 column, 4 row table into the letter/document?
change the font and font size that are used in the letter/document?
insert page numbers into the letter/document?
name and save the letter/document file into a particular folder on your computer?
2. Do you know how to search for files on a computer?
3. Do you know how to connect to the internet?
4. Do you know how to enter an address into the search box of a browser in order to visit a
desired web site?
5. Do you know how to use a search engine such as Google or Yahoo to search for information
on the internet?
6. Do you have experience using a learning management system such as Desire2Learn (D2L),
Blackboard/WebCT, or eCollege as part of an online or hybrid/web-assisted class?
7. Do you possess other technology skills? If so, please elaborate:
NOTE: For assistance in achieving basic computer literacy, please contact MTSU College of Continuing Education
and Distance Learning at 615-898-2462. (Application continues on next page)
Page 2
Name: ______________________________________
Application Essay:
It is important that prospective students have given proper consideration as to why they want to obtain a
master’s degree in counseling. The Professional Counseling faculty is particularly interested in knowing
why you want to become a clinical mental health counselor or school counselor. In addition, given that it
is important for students in a helping profession to be open to self-examination and personal and
professional self-development, provide examples of how you have successfully engaged in these
activities in the past and/or how you would accomplish these things in the future should you be admitted
into the program.
Please provide in the space below a typed essay (600 words or less) discussing significant milestones and
events in your life which have led you to the decision to become a clinical mental health counselor or
school counselor. In addition, provide information regarding your openness to self-examination and
personal and professional self-development. If you need additional space, please include any additional
pages.
Concentration:
______Clinical Mental Health Counseling
_____School Counseling
______School Counseling License (Adding to Previous Master’s)
Essay:
(continue on next page if necessary)
Page 3
Name: ______________________________________
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