Department of Graduate Studies

 

APPLICATION FOR GRADUATE STUDY IN PSYCHOLOGY

 

Please type or print (Fill in All Blanks)    Social Security Number           ________/_______/_________

MS.     MRS.   MR.

 

 

                LAST                                       FIRST                                      MIDDLE                                                 MAIDEN

 

Prefer to be called _______________________________________                     Former Last Name(s) _____________________________________________

 

 

Mailing Address: ________________________________________________________________________________________________________________________

                                                Number and Street (or P.O. BOX)                            City                         State                                        Zip

 

County: ______________________________________________________       Email Address ___________________________________________________________

 

Home (______) _______-__________     Work (______) ________-___________    Cell (_______) ________-___________    Fax (_______) ________-___________

 

Place of Employment ____________________________________________________________________________________________________________________

Date of Birth:        _________/_________/___________                                                      Gender:    Male   Female

Religious Preference: ____________________________________                                       Church Membership:                Yes      No

Race:  (Optional)     American Indian                 Asian       Black      Hispanic       White, Non-Hispanic     Other

Marital Status:          Single      Married     Divorced     Widowed          Spouse’s Name_____________________________________________________

US Citizen?   Yes                 No           If not, where are you a citizen? ________________________________________________________________________________

Union Graduate:       Yes         No                                                                  Visiting Student:     YES       No

Term Entering:        Fall         Spring     May      Summer I      Summer II

Program Entering:   General (36 hrs)   Clinical (45 hrs)     Counseling (45 hrs)     School (45 hrs)

                                               

GRE Scores:   Verbal ____________________________    Quantitative _______________________________ Analytical ___________________________________

 

 

Do you have Transfer Work?   Yes      No                     Institution(s)_______________________________________________________________________________

 

Colleges and Universities Attended

               

                Institution and State                                                 Dates                                       Degree                                                     Major

 

__________________________________________            _______________________  _________________________                   _________________________________

 

__________________________________________            _______________________  _________________________                   _________________________________

 

__________________________________________            _______________________  _________________________                   _________________________________

 

 

*To complete your application we must receive an official transcript from the institutions listed above, these transcripts must be send directly to the Union College Graduate Office.  Your application should be accompanied with a $25 application fee.  You MUST contact the Graduate Office upon submitting this application to develop a planned program or a graduate hold will be placed on your account.

 

I CERTIFY THAT THE ABOVE STATEMENTS ARE CORRECT AND COMPLETE:

 

Signed: ________________________________________________________________________________      Date: _______________________________________

 

ID Number_________________________________Pin Number______________________   Email Address: ____________________________________________

 

*How did you hear about our program? ____________________________________________________________________________________________________