California State University, Los Angeles
Charter College of Education
Division of Special Education and Counseling
Joint Doctor of Philosophy in Special Education
Program Application
Application Date:
Name:
Address:
Home Phone:
Cell Phone:
E-mail:
Educational Background
Date
Institution
Major
GPA
Bachelor’s Degree
Master’s Degree
Credential
Credential
Other
(please specify)
Professional Experience with Exceptional Individuals
From
Date
-
To
Type of Assignment
School District/Agency
GRE: Date Taken: ______________________
Verbal
________
Analytical
________
Quantitative
________
Total
________
CSULA Admission Status
Matriculated: YES
NO
If yes, date admitted:
California State University, Los Angeles
Charter College of Education
Division of Special Education and Counseling
Joint Doctor of Philosophy in Special Education
Statement of Intent
Name:
Please respond to the following questions:
1. What are your reasons for applying to the CSULA/UCLA Joint Doctoral Program?
2. What are your career goals following the completion of your doctorate. Please address both your shortterm (first five years) and long-term goals
3. What is your estimated timeline for completion of the doctorate?
4. Describe any research activity in which you have participated. Briefly describe each study and the role
you played.
5. What are your research interests?
6. Why do you believe you will make a good doctoral candidate?
California State University, Los Angeles
Charter School of Education
Joint Doctor of Philosophy in Special Education
Reference Letter
Applicant's Name:
______________________________________________
Applicant's Address:
______________________________________________
______________________________________________
This individual is an applicant for the Joint Doctor of Philosophy in Special Education program between California
State University, Los Angeles and University of California, Los Angeles. Please indicate how long and in what
capacity you have known the applicant. Evaluate the applicant's suitability for doctoral studies as well as your
impression of this individual as a future leader in the field of Special Education. Please feel free to use additional
sheets of paper for your reference letter.
Signature: _______________________________
Name:
_______________________________
Position:
_______________________________
Address:
________________________________
Phone:
________________________________
Return Reference Letter to: Joint Doctoral Coordinator
Division of Special Education and Counseling
Charter College of Education
California State University, Los Angeles
5151 State University Drive
Los Angeles, CA 90032
This recommendation will be available for the applicant's review
This recommendation will be not available for the applicant's review