Eastern Michigan University Department of Psychology Clinical Behavioral Psychology M.S. Program (PSYB) Application Application Deadline: February 1

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1 Eastern Michigan University Department of Psychology Clinical Behavioral Psychology M.S. Program (PSYB) Application Application Deadline: February 1 First Name: Middle Name: Last Name: Gender : Female Male Transgender Other Ethnicity: Race: Current Address: Permanent Address: City, State Zip: City, State Zip: Primary Phone Number: Cell Home Work Secondary Phone Number: Cell Home Work Address (required): Are you an international student applicant (not a U.S. citizen/permanent resident OR currently have or will require a visa to live, work, or study in the United States)? Yes No If yes, please contact the Office of International Graduate Admissions for additional required documents. Only school transcripts submitted to Educational Perspectives will be used for admissions. Did you also apply to the EMU PhD program in Clinical Psychology? Yes No IMPORTANT NOTE: If yes, previously submitted materials will be accessed from that program s files; there is no need to re-send transcripts, recommendation letters, GRE scores, writing samples, CV, or the Graduate Application if you have already submitted those materials as part of your application to the Doctoral program. You do not need to pay the application fee again. But, you do need to complete an Enrollment Change Form and we DO need this CB MS Application on file to consider you for the CB MS (PSYB) program. Please provide your educational background below (list most recent first): *Note: you MUST include any institution that you attended from which you received college credit. Degree Type Level Degree Date City, State Dates Attended Completed/ Institution Name (Graduate/ (mm/yy) Country (mm/yy-mm/yy) Expected Undergraduate) if applicable (BA, BS, etc.)

2 Undergraduate Major 1: Undergraduate Major 2: Type of Graduate Program(s) if applicable, e.g., Clinical Psychology: Indicate your Psychology Undergraduate courses completed to date: Course Number Credit Institution Where Course Title (e.g., PSY 101) Hours Taken Semester Taken Grade If not obvious, which course covered Statistics and Experimental/Research Methods Total Psychology Undergraduate credit hours completed Clinical Experiences list your clinically relevant experiences (if any), including activites engaged in as a mental health worker, occupational therapist, paramedic, hot-line counselor, teacher, volunteer, student in a mental health setting, etc. Job Title Responsibilities Dates/Hours Worked Paid or Volunteer Nature/Amount of Supervision

3 Research Experiences list your research experiences (if any). Additionally, you can submit abstracts or reprints of any articles and/or relevant research papers. Setting Length of Description of Population(s) Nature/Amount (lab, hospital, Responsibilities Time Involved Presentations or Studied of Supervision institute, etc.) in Project Publications Diversity (optional): Our program values diversity. Please indicate how you might contribute to the diversity of our program (e.g., age, disability, ethnicity, gender, gender identity, language, national origin, race, religion, culture, sexual orientation, social economic status, etc.) as well as any relevant multicultural experiences. Please limit response to 75 words or less. Have you ever been convicted of a felony or a misdemeanor (other than a traffic violation)? Yes No If yes, please provide explanation below. By submitting this application, I certify that all information in this form is complete and accurate to the best of my knowledge, and that I have listed ALL institutions previously attended. I understand that misrepresentation or omission of any information may be cause for denial or cancellation of my admission OR may result in my being suspended or dismissed from Eastern Michigan University, if discovered subsequent. I understand that all pertinent rules and policies of Eastern Michigan University apply to me immediately upon admission and that it is my responsibility to become knowledgeable about them. I understand that all credentials submitted in support of this application become the property of the University and are not returnable.

4 Essay Questions answer BOTH questions in the space provided. 1. Personal statement Tell us about significant life experiences and people that have shaped your career choice, the impact of your clinical and research experiences thus far, your special interests, and your personal goals as a psychologist. Please limit response to 3500 characters.

5 2. Interests and fit with our program What types of behavior of psychological problem(s) would you be most interested in understanding better through research and/or clinical work. Explain what particular theoretical approaches to therapy or to researching clinical problems you would favor and why. Please limit response to 3500 characters.

6 References We require three letters of recommendation, preferably from psychologists. At least one letter should be from a supervisor or teacher who is familiar with your clinical and/or academic work. Use the Letter of Reference form from the website. Please provide the information below regarding you references. Name Address Business Phone Number *Note: You will need to complete the top portion of the Letter of Reference form and provide it to your letter writers who will, in turn, complete the form, attach a letter, and submit both documents directly to the department via mail or (psy_cbgrad@emich.edu). This table is for informational purposes only and Eastern Michigan University is not responsible for contacting your letter writers. Notification of Application Decision The program holds an Open House/Interview Day for the most qualified applicants in March. By May 1, we will contact you via if you are being recommended for admission to the CB MS program. Official notification will follow in writing from Graduate Admissions, pending approval of recommendation. Applicants will be advised in writing if they are not recommended for admission. Such notice will be sent at the earliest possible date. It is the policy of Eastern Michigan University not to discriminate against any individual on the basis of race, color, religion, national origin, sex, sexual orientation, marital status, age, handicap, or veteran status in matters of admissions, employment, housing, or services or in the educational programs or activities it operates, in accordance with civil rights legislation and University commitment. Eastern Michigan University and the Psychology Department reserve the right to change any statement in this program concerning, but not limited to, rules, policies, tuition, fees, curricula, and courses.

7 WHAT TO SEND AND WHERE Graduate Admissions Documents to Send (Note: not necessary to resend if you applied to the PhD program initially) Official GRE scores Official English Language Proficiency Test Scores if required Graduate Admissions Application hard copy: online application: Official Transcripts (from ALL schools in which college credit was received) Eastern Michigan University Office of Graduate Admissions P.O. Box 970 Ypsilanti, MI Graduate Application Fee ($35 paper or $25 online submission) Department Documents to Send BY MAIL (Note: not necessary to resend if you applied to the PhD program initially) Official Transcripts (from ALL schools in which college credit was received) NOTE: You MUST send transcripts directly from the institution to BOTH the Psychology Department AND Graduate Admissions (noted above). Ashley Stauffer Department of Psychology 341 Science Complex Ypsilanti, MI Department Documents to Send Electronically BY Department Application (REQUIRED FOR ALL APPLICANTS) Curriculum Vita Writing Sample that demonstrates scholarly ability (typically a research paper) Ashley Stauffer psy_cbgrad@emich.edu Recommendation Letters (Note: not necessary to resend if you applied to the PhD program initially) Complete the top portion of the Letter of Reference form and provide it to your letter writers who will, in turn, complete the form, attach a letter, and submit both documents directly to the department via mail or . The Letter or Recommendation form can be downloaded from our website. Eastern Michigan University is not responsible for contacting your letter writers. Ashley Stauffer Department of Psychology 341 Science Complex Ypsilanti, MI or psy_cbgrad@emich.edu *McNair Scholars must submit a paper application and verification of participation in the program in order to receive the application fee waiver. ALL APPLICATION MATERIALS MUST BE SUBMITTED BY FEBRUARY 1 IN ORDER TO BE CONSIDERED. Late submissions will not be considered.