PSYCHOLOGY SCHOOL OF HUMAN AND COMMUNITY DEVELOPMENT DEPARTMENTAL APPLICATION FORM FOR POSTGRADUATE PSYCHOLOGY STUDIES

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1 PSYCHOLOGY SCHOOL OF HUMAN AND COMMUNITY DEVELOPMENT DEPARTMENTAL APPLICATION FORM FOR POSTGRADUATE PSYCHOLOGY STUDIES MA in Organisational Psychology (closing date 30 th September 2015) 1. Your Personal Details: 1 Surname 2 First Names 3 Wits Student no. (from online application) 4 Gender 5 Race 6 Cell no. 7 1

2 Equity Criteria In line with the School s Postgraduate Selection Policy, this section captures information on factors related to your equity status. Note: The information you provide below may be independently audited to evaluate its accuracy. Knowingly providing false information will be grounds for permanent exclusion from all postgraduate degrees in the School. Unless otherwise indicated, please tick the appropriate block Race Black White Indian Coloured (list selfidentification) Citizenship South African SADEC African (list country) Gender Male Female (list self-identification) Disability No Yes If yes, please describe your disability Home language(s) languages Guardian(s)/ Parent(s) Level of proficiency (tick appropriate box) Beginner Intermediate Fluent Profession(s)/occupation(s) Highest level of education Name of high school attended Type of high school attended (tick appropriate box) Private Public urban Public township Public rural Have you ever been the recipient of NSFAS funding? If yes, for how many years? Did you work during your studies? If so how many hours per week on average? If you answered Yes to the previous question, which job(s) did you do, and for how long? How will you fund your studies if accepted into the programme? Yes No Number of years Yes No Number of hours Self Parents Scholarship/ bursary (specify) Please describe any other significant obstacles that you feel you have overcome in order to be in a position to be considered for this programme (attach additional pages if required) Declaration: I hereby declare that all information I have provided above is accurate to the best of my knowledge. Signed: Date: 2

3 ACADEMIC RECORD PLEASE ENSURE THAT AN OFFICIAL UNIVERSITY TRANSCRIPT OF YOUR ACADEMIC RECORD IS SUBMITTED WITH YOUR APPLICATION (A PHOTOCOPY CERTIFIED BY A COMMISSIONER OF OATHS WOULD BE ACCEPTABLE) 1. What degree (if any) are you currently completing? Degree:... University: List all the subjects you are registered for in your current degree and provide the marks that you have achieved to date. Do not list subjects that appear in your transcript (unless you are repeating a subject), or part marks in the form of essays, tests or assignment Subject Mark or Symbol 3

4 Please list any courses that you have completed or are presently completing that include (a) research design and (b) statistics. Please list these clearly below and state the proportion (as a percentage) of the course devoted to these aspects, as well as the marks obtained. Research Design Course in Which Covered Proportion of course which covered RD/Stats Percentage obtained for that section of the course. Statistics TRAINING AND EMPLOYMENT 1. Specify any work experience (formal and/or informal) you may have had. A Organisation Job Title Dates Full Time/ Part Time From To B C D 4

5 1. What Research Experience do you have? (E.g. Previous postgraduate degrees, Undergraduate research projects, work as a research assistant or at a research institute etc.) 2. Please describe your research interests. 3. Please provide any additional relevant information in support of your application Checklist for this application: (Note that your application is not complete if anything is missing from the list below) The Wits Online application form available on (https://www.wits.ac.za/applications/portal/index ) which you should have already completed Departmental Form Transcript of results (undergraduate degree) A marked essay (non-wits students only) Two Reference Reports 5

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