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CHILD GUIDANCE CLINIC (North-West University)

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UNIVERSITY OF CAPE TOWN
CHILD GUIDANCE CLINIC
APPLICATION FOR ADMISSION TO
M.A. (CLINICAL PSYCHOLOGY) TRAINING PROGRAMME
Please email this form and supporting documents to: clinicalmasters@uct.ac.za Closing date for
applications is NOON on Friday 27
th
May 2022. No late applications will be considered.
TITLE:
SURNAME:
FIRST NAME:
Please use your name as stated on your ID Document (no abbreviations, nicknames, preferred names
unless legally changed)
AGE:
DATE OF BIRTH:
ADDRESS:
CELL:
EMAIL:
Please report any change of contact details immediately.
The above information is required – please ensure you fill in all the information requested.
How would you describe yourself according to the following categories as defined in the SA Employment
Equity Act 55:
Please select:
Disabled White
Black
African
Black
Coloured
Black
Indian
Other
HARD COPY APPLICATIONS
WILL NOT BE ACCEPTED
v
ALTERNATIVE CONTACT No.:
POSTAL CODE:
LANGUAGES
Which languages are you verbally fluent in?
Which other languages would you be able to
consult with clients in?
Post-graduate
EXPERIENCE
Current and/or completed relevant work/volunteer experience:
Where you worked: (NGO,
CBO, NPO, School etc.)
Period (mm/yyyy to
mm/yyyyy) and duration
in months
What did you do?
Provide a brief description of your role.
Date
completed or
estimated date
of completion
Degree University
Areas (state all
areas covered
in Hons)
Percentage
achieved (if
available)
Research project
or thesis title
Date completed Degree University Majors
Percentage
achieved for 3
rd
year Psychology
QUALIFICATIONS
Undergraduate
Number of
hours /
week
Provide us with a reflection on your experience working in the settings listed above, include
an example of a situation that you found challenging or uncomfortable. Use the space provided below.
(No more than 300 words):
REFEREES
Please ask two referees to complete the Referee Report Form and to return directly to us by the due
date. Please note referees must be from either an academic or professional context in which you have
engaged.
Name of Referee Contact number Email address
In what capacity
does the referee
know you?
How long has the
referee known you?
How do you understand how your history and life experiences have shaped who you are today and
your deeper, more personal motivations for wanting to become a clinical psychologist? Use the
space provided below. (No more than 500 words):
APPLICATION CHECKLIST
Please complete the checklist below to confirm that you have included all the required
documentation, in one separate PDF document, in the following order:
Progress report for Hons if currently registered (leave
unchecked if not applicable)
Full academic transcript (undergraduate first, then postgraduate)
Degree certificates (undergraduate first, then postgraduate)
SAQA certification (leave unchecked if not applicable)
Proof of payment for application fee
Please refer to http://www.childguidanceclinic.uct.ac.za/cgc/courses/applications for banking details
and other information regarding the application and selection process.
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CHILD GUIDANCE CLINIC (North-West University)

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Completed 1 April 2022

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