Mental Health Counseling Master of Science
Application for Admission
(Please Type)
Name:
First Name
Middle
Address:
Street Address
Phone:
Home
Last Name
City
Work
Email:
State
<janedoe@yahoo.com>
1. Educational History (use additional pages if necessary):
DEGREE MAJOR
INSTITUTION
example:
B.S.
Psychology
Univ. Central Arkansas
None
General Studies
Undergraduate GPA
Major GPA
05//06/2012
Aug 2009-May
2010
INSTITUTION
example: PSYC 1300
<x.xx>
<x.xx>
2. Graduate Record Exam (GRE)
DATE
Arkansas State Univ.
Completed semester hours of psychology prerequisite coursework:
COURSE TITLE
COURSE NUMBER
General Psychology
Psychological Statistics
Research Methods
Abnormal Psychology
Theories of Personality
Univ. Central Arkansas
Graduate GPA (if applicable)
Verbal <xxx>
Zip
Quantitative
GRADE
A
<x.xx>
<xxx>
Three letters of recommendation from former professors or individuals otherwise qualified to comment on your
academic performance and potential for graduate study as a professional counselor.
Name
Position
Example:
Dr. Jane Doe
Assoc. Prof. of Psychology, Univ. Central Arkansas
Dr. Will Jacobs
Instructor of Psychology, Arkansas State Univ.
Rebecca James
Supervisor, Youth Home
Please attach: Essay A – Statement of Career Path and Aspirations – a 500-word essay focusing on your career aspirations as a counselor.
This may include: a) significant people or events that have led you to pursue a career in psychology, b) strengths and
limitations and c) career plans as a licensed professional counselor.
Signature of Applicant
Date
Send application materials to
Mental Health Counseling Director of Training
University of Central Arkansas, 201 Donaghey Ave., UCA Box 4915,
Conway, Arkansas 72035-0001
DEADLINE for fall admission: January 15