APPLICATION FOR PROFESSIONAL PROGRAMME IN COUNSELLING OR CLINICAL PSYCHOLOGY 2017 Surname: First names: Postal Address:

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1 APPLICATION FOR PROFESSIONAL PROGRAMME IN COUNSELLING OR CLINICAL PSYCHOLOGY 2017 Surname: First names: Postal Address: Date of Birth: Age on 15 August 2016: Telephone(s): Fax: Paste your photo here Name and contact telephone number of a friend/relative that we can contact if we are having difficulty contacting you: University at which you are currently studying / studied for your Psychology Honours/4 th Year BPsych degree: Have you applied for a place in this or other courses course previously? If so give details. (It is important to include in your motivation statement what feedback you received and how you have responded this.) Which course do you wish to apply for? YOU MAY CHOOSE ONLY ONE. Counselling Clinical Page 1 of 5

2 PERSONAL DETAILS Please rate your language proficiency as good / average / weak / none Year Languages Understand Speak Read / Write English isixhosa Afrikaans Other Nationality: Race Black White Coloured Indian Sex: Female Male UNDERGRADUATE PSYCHOLOGY RESULTS University Average Marks for Psychology (Please calculate the aggregated mark for your Psychology 1, 2 and 3 credits) Psychology 1 (Average of all Psychology 1 credits) Psychology 2 (Average of all Psychology 2 credits) Psychology 3 (Average of all Psychology 3 credits) POSTGRADUATE PSYCHOLOGY RESULTS What is the status of your Honours Degree in Psychology? % Current Completed Year University Psychology Honours Credits % If you have completed your honours degree in Psychology, what was your overall result? (%) OTHER POSTGRADUATE ACADEMIC QUALIFICATIONS Year University / College Course (For example, PGCSE, MA, PhD etc) Result Please remember to also attach a full academic record detailing all of the courses that you have completed at University. Page 2 of 5

3 RELEVANT WORK / VOLUNTARY EXPERIENCE IN COUNSELLING / HELPING / CARING (Describe your involvement) Page 3 of 5

4 SUMMARY OF RELEVANT LIFE EXPERIENCES (Add extra sheets if you don t have enough space) Personal psychotherapy Training courses and workshops Leadership experience Other relevant experience Referee s Name, Telephone & Address. 1 NAMES & DETAILS OF THREE REFEREES Position & Institution Capacity (How does this person know you and on what can she or he comment?) 2 3 PLEASE NOTE: You must send each referee a copy of the Referee Report Form, and your referees must send the completed form directly to us. Please inform your referees that the forms should reach us before the closing date of 10 June It is your responsibility to ensure that we receive the referee reports on or before the closing date. Page 4 of 5

5 ATTACHMENTS 1 Autobiography Write a personal account of your life in about 1000 to 1500 words. Include important life experiences, formative influences, the range of your interests and activities etc. We are interested in how well you can provide a psychologically insightful account of your personal development and an honest self-appraisal of your strengths and weaknesses. 2 Statement of Motivation Write a statement of motivation (approximately 300 words) indicating why you wish to train as a psychologist. We are interested to see whether you understand what a career as a professional psychologist involves in practice and why you think you are suited to this kind of career. Explain why you are choosing clinical or counselling psychology. If you have applied for a place in this course previously but were unsuccessful, please include a statement about the feedback you received at the time and what you have done to address that feedback and to make yourself more eligible as a candidate. 3 Academic Transcripts Please provide us with the official records of all results achieved in University courses. This should include not only courses in psychology but any other courses, diplomas or degrees you have studied for at a University. Students currently completing their psychology honours programme should, if available, provide their June examination or other results. 4 R150 Administration Fee This can be in the form of a cheque or postal order made out to the Rhodes Psychology Clinic. Alternatively, you may deposit or transfer the money into our bank account and attach proof of payment to this application: First National Bank Branch: Grahamstown Branch code: Account: Applications cannot be processed if payment is not received. Send the completed form and all attachments to: The Secretary, The Psychology Clinic, Rhodes University, PO Box 94, Grahamstown 6140 (Or PDF copies to y.scheepers@ru.ac.za) THE CLOSING DATE FOR APPLICATIONS IS FRIDAY 10 JUNE 2016 Regardless of whether you send a hard or electronic copy, you should check with Mrs Yvonne Scheepers, at y.scheepers@ru.ac.za or that your complete application has been received. Page 5 of 5