Rev 8.1.2014
Counseling Psychology Emphasis*
Application for Admission
(Please Type)
Name:
First Name
Middle
Address:
Street Address
Phone:
Home
Last Name
City
Work
Email:
State
<janedoe@yahoo.com>
Educational History (use additional pages if necessary):
DEGREE MAJOR
INSTITUTION
example:
B.S.
example: Psychology
example
DATE
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>
Psychological Statistics
<A>
<A>
Research Design
<A>
<A>
Graduate Record Examination (GRE) Scores:
Undergraduate GPA
Major GPA
<x.xx>
<x.xx>
Abnormal Psychology
<A>
Verbal <XXX> Quantitative <XXX>
Graduate GPA (if applicable)
Last Two Year GPA
<x.xx>
<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