Fillable Supplemental Application for the Department of Psychology DO (Western Michigan University)

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Supplemental Application for the Department of Psychology DO (Western Michigan University)

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Supplemental Application for the Department of Psychology
DO NOT CHANGE FORMAT OF DOCUMENT; SKIP AREAS IF NEEDED BUT DO NOT DELETE THEM
Updated 11.2019
Name:
Email:
Phone:
1. OFFICIAL TRANSCRIPTS, OFFICIAL GRE SCORES, AND ALL APPLICATION MATERIALS MUST ARRIVE
BY:
a. Metro Detroit - Hybrid Program: September 15 (Classes start in January)
b. All Other Programs - December 1
2. UNOFFICIAL TRANCRIPTS FOR ALL SCHOOLS ATTENDED SHOULD BE INCLUDED IN APPLICATION
EDUCATION HISTORY. OFFICIALS FOR ALL DEGREE AWARDING AND GRADUATE LEVEL SCHOOLS
ARE REQUIRED.
3. UNOFFICIAL (SELF-REPORT) GPA AND GRE SCORES. Reported GPAs will be verified by official
transcripts. Inaccurate self-reports will result in the elimination of an application from further
consideration. You must still send official GRE scores.
Unofficial GPA
Undergrad Institution Name:
Overall GPA:
Psychology GPA:
Graduate Institution Name:
Overall GPA:
Undergrad Institution Name:
Overall GPA:
Psychology GPA:
Graduate Institution Name:
Overall GPA:
Undergrad Institution Name:
Overall GPA:
Psychology GPA:
Graduate Institution Name:
Overall GPA:
Undergrad Institution Name:
Overall GPA:
Psychology GPA:
Graduate Institution Name:
Overall GPA:
Unofficial GRE – You may report more than one test to indicate the best scores by area
Date Taken: Verbal Score: Quantitative Score: Analytical:
Date Taken: Verbal Score: Quantitative Score: Analytical:
Date Taken: PSY Subject Score:
Have not taken the GRE. I am scheduled to take it on:
4. Which program are you applying for (check only one primary, you may select multiple secondary)?
☐Behavior Analysis
☐MA: Main Campus ☐MA: IPA ☐MA: Metro Detroit – Skip step 5 ☐ Ph.D.
☐Industrial Organizational Behavior Management
☐MA: Practicum ☐ MA: Thesis ☐Ph.D.
☐Clinical Ph.D. (no terminal MA program) -- Skip step 6
Supplemental Application for the Department of Psychology
DO NOT CHANGE FORMAT OF DOCUMENT; SKIP AREAS IF NEEDED BUT DO NOT DELETE THEM
Updated 11.2019
5. ADVISOR. List, in order of preference, the faculty member(s) whose research and practice interests
best match your interest. Please identify up to 4 faculty members. Do not leave blank. (See website
for list).
2.
4.
6. FOR BA AND IO ONLY: What behavior analysis books have you read?
Author
Title
ALL APPLICANTS COMPLETE BELOW SECTION
7. What psychology courses have you taken?
Course Number and Title
Was this a Behavior
Analysis Course?
Professor
Grade
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
Supplemental Application for the Department of Psychology
DO NOT CHANGE FORMAT OF DOCUMENT; SKIP AREAS IF NEEDED BUT DO NOT DELETE THEM
Updated 11.2019
8. Why are you interested in this program at WMU? (check all that apply)
☐The location of your current job
☐You have friends or family near by
☐Its emphasis on behavior analysis
☐Its emphasis on industrial/organizational
psychology
☐Its emphasis on evidence-based practice
☐Its emphasis on contemporary behavior
therapy/cognitive-behavioral therapy
☐Program reputation
☐Science-practitioner model
☐Faculty member you wish to work with
☐Other: (please explain)
9. Career Goals:
9.
For those applying to an MA program.
For those applying to a Ph.D. program.
After graduating with an MA, you plan to:
After graduating with an Ph.D, you plan to:
☐Work full time
☐Pursue a Ph.D., then work as a consultant
or practitioner
☐Pursue a Ph.D., then teach at a
college/university or pursue a research
position
☐Other (please specify)
☐Work as a consultant or practitioner
☐Teach & research at a
college/university
☐Pursue a research position in an
academic setting/ medical school
☐Practice in a healthcare setting
☐Become a private clinical
practitioner
☐Work in program administration and
evaluation (e.g., in healthcare or educational
setting)
☐Other (please specify)
10. Will you be able to attend school full time (6+ credit hours)?
☐Yes
☐No
11. History of criminal convictions*
I ☐ have**, ☐ have not ever been convicted of a criminal offense.
If I have, the conviction was:
* Applicants should understand that falsification of information is grounds for immediate dismissal of
your application and dismissal from any program into which you were admitted based on the
falsification of this item. Matriculation in some programs (i.e., clinical) requires students to submit to
formal background checks.
** Applications should understand that felony convictions do not preclude you from being considered
for graduate training but will likely limit opportunities for practicum and internship placement,
professional licensing, and future employment.
Supplemental Application for the Department of Psychology
DO NOT CHANGE FORMAT OF DOCUMENT; SKIP AREAS IF NEEDED BUT DO NOT DELETE THEM
Updated 11.2019
12. Statement of Rehabilitation
Applicants with criminal records must provide a written statement addressing consequent learning
and/or rehabilitation. Briefly describe your rehabilitation here. Use an additional sheet if necessary.
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Supplemental Application for the Department of Psychology DO (Western Michigan University)

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Completed 2 August 2020

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