Master of Arts Human Services Degree Program Emphasis in Addiction Counseling*

Transcription

1 Master of Arts Human Services Degree Program Emphasis in Addiction Counseling* * Pending approval of the Kansas Board of Regents Information Booklet/Student Policy Manual And APPLICATION PACKET Flexible Course Offerings Small Classes Experienced Faculty Department of Human Services Washburn University Topeka, Kansas 1

2 PROGRAM DESCRIPTION The Master of Arts in Human Services Degree Program at Washburn University was approved in the 2012 spring semester by the Washburn Board of Regents. Students may apply to the program for the Fall 2012 semester but are advised that the program is awaiting final approval from the Kansas Board of Regents. For updates on the status of the program, please contact the Human Services Department at or For the professional currently employed in the field, advanced knowledge and skills acquired in this MA program can enhance opportunities for career advancement. The degree program is also designed to prepare the graduate for licensure as a clinical addiction counselor (LCAC) with the Behavioral Sciences Regulatory Board (BSRB) in Kansas. In addition, the MA in Human Services degree program prepares students for teaching positions in community colleges and for additional graduate study. Course work emphasizes the application of theory and research to the delivery of human services with an emphasis in addiction counseling. Course scheduling and delivery methods are flexible and designed to meet the scheduling needs of students, including online courses and short courses such as weekend workshops. I. ADMISSION A. Entrance Requirements: Admission to the MA in Human Services will be based on a review of appropriate application materials. A committee of faculty from the Department of Human Services will be selected to review application materials and make recommendations regarding admission to the program. Students applying for admission to the Master s program will submit a completed application, copy of undergraduate (and graduate, when applicable) transcript(s), three letters of recommendation from instructors and/or professionals in the field, and a written essay describing the student s intent and goals in pursuing the Master s degree. Minimum standard for admission to the Master s program is the completion of a Bachelor s degree in Human Services or a related field (e.g., Social Work, Psychology, Nursing, etc.) from an accredited institution of higher education with an overall GPA of 3.0 (on a 4.0 scale) over the last two years (60 credits) of university coursework. Students should be aware that the Kansas Behavioral Sciences Regulatory Board requires that applicants for licensure as a clinical addiction counselor (LCAC) must meet, in addition to the required graduate-level coursework, all the requirements for licensure as an addiction counselor (LAC). The LAC requires a Bachelor s degree in a helping profession, 33 hours of coursework in addiction counseling, and a passing score on a national examination. Students wanting clarification on BSRB requirements should contact the BSRB directly. Continuous full-time enrollment in the MA program is expected. Continuous enrollment requires satisfactory completion of at least three courses (9 credit hours) in each of the 2

3 fall and spring semesters. If the student discontinues enrollment for two semesters or more, readmission is required. Should readmission be granted, it will be based on the requirements and regulations effective at the time of readmission. B. Advanced Placement Option: Students who have completed a BAS degree in Human Services from Washburn University or another institution or similar degree program may apply for course substitutions or waivers by speaking with their advisors after they have been admitted. However, students should be aware that the Kansas Behavioral Sciences Regulatory Board (BSRB) requires specific coursework to be eligible for the LCAC and we cannot guarantee that substitutions acceptable to Washburn will be acceptable to the BSRB for state licensure. C. General Requirements for Admission The admissions process is straightforward. Students submit the requested application materials by the deadline. Completed application packets are then reviewed by the Human Services Department Admissions Committee. Admission to the department is selective. The Department of Human Services can, and sometimes will, deny admission of applicants. This indicates that the applicant either lacks the necessary prerequisites or, in the opinion of the faculty, lacks the skills needed for successful completing of the degree program at the present time. This application packet may be downloaded from the Department website at the following link: Application Steps: 1. Applicants must have an official transcript sent directly to the Washburn admissions office from the institution where the credit was granted to show that the applicant has earned a Bachelor s degree from a four-year accredited college or university. Washburn graduates are not required to submit transcripts, but a Bachelor s Degree must be posted on their transcript before they will be considered for admission to the MA in Human Services program. If the applicant has graduate credit that they want to have considered for possible course substitutions, the applicant must also have any official graduate transcripts sent directly to the Washburn admissions office from the institution where the credit was granted. This step is not required of students who received graduate credit from Washburn. 2. The applicant must also send copies of official transcripts to the Department of Human Services. As above, if the applicant's Bachelor s degree and/or previous graduate coursework was completed at Washburn, s/he is not required to submit copies of transcripts to the Department. 3

4 3. Applicants must complete and submit an Application for Formal Admission to Washburn University. This step is in addition to completing the Department s application packet To fill out a University application for graduate study, please go to the following link and select application : 4. Applicants must submit a completed application form (attached to the end of this document) to the Human Services department. This form requires applicants to write a personal biographical statement explaining (a) personal philosophy of human services with special consideration to the area of addiction/recovery services and (b) reasons for entering the program. 5. Applic ants must subm it three reference form s from persons who are in a position to attest to the applicant's academic abilities and potential for graduate study, such as former instructors, internship supervisors, and work supervisors. References from former professors are welcomed, but may not be from the Human Services Department Chairperson or members of the Admissions Committee. The reference forms are included at the end of this application packet and must be submitted in sealed envelopes, with the signature of the person completing the reference across the seal. 6. A $35 non-refundable application fee is required at the time of application and must accompany the completed Application for Admission form. The check should be made out to Washburn University with the notation at the bottom of the check for Masters of Arts: Human Services Application Fee. 7. Summary: I. The applicant must submit the following to the admissions office: 1. Official transcript, sent directly from the institution from which the student received credit (waived if the student graduated from WU). 2. A formal university application for graduate study. II. The student must submit the following packet of materials to the Human Services Department at the address listed below: 1. copies of official transcripts (waived if these are from WU); 2. the completed program application form with the 4

5 biographical statement; 3. three completed reference forms in sealed envelopes with signature of reference across the seal; 4. a non-refundable check for $35 made out to Washburn University. III. Completed admission packets should be delivered or mailed to: Graduate Program Director, Department of Human Services, 311 Benton Hall, Washburn University, 1700 SW College Ave, Topeka, KS Deadline for Fall 2012 semester: All materials must be submitted by May 4th to be considered for admission for fall 2012 semester. 9. Note: Acceptance is not automatic. To become admitted to the MA program, the applicant must receive the recommendation of the Human Services Graduate Admissions Committee. D. Notification When a decision has been made regarding your application for study in the Master of Arts in Human Services with an emphasis in Addiction Counseling, you will receive a letter from the Human Services Department which indicates your admission status. If admitted, you will be instructed to contact the department for advising purposes. NOTE: Notification from the Admissions office that all transcripts have been received, and that you have been admitted to Washburn University, does not mean that you have been admitted to the Masters of Arts in Human Services program. E. Transfer of Academic Credits Students who are admitted as a "full-standing" student may transfer a maximum of 6 semester hours of relevant graduate course work from another university or another Washburn department. These will be considered on a case-by-case basis. The applicant must have received a grade of B or better in the course(s) being considered for transfer. F. Life/Work Experience The Washburn Master of Arts in Human Services Program does not award college credit for life/work experiences. II. TUITION Tuition and fees are established by the Board of Regents and are subject to change at any time. All payments are made to the University business office. The tuition charge is applicable to all terms of work such as regular semester, evening program, etc., whether taken for credit or as an auditor. Information regarding tuition, student activity fees, parking, etc., can be found in the Washburn University catalog. 5

6 III. ADVISING AND REGISTRATION Upon admission to the Master of Arts in Human Services program, students will be advised by Human Services department faculty, who will assist students with selecting and scheduling courses. Students must contact a Human Services graduate advisor at least once each semester prior to enrolling in the next semester. In cooperation with the advisor, students are expected to complete a plan of study as soon as possible after entering the program. Faculty members usually restrict themselves to advising you about course work and career objectives. NOTE: Graduate students in the Human Services department are not permitted to enroll in any undergraduate course work without written permission from their Human Services department faculty advisor. Students who violate this rule may be administratively withdrawn. All students are advised to take advantage of advanced registration. Advanced registration gives you an opportunity to review your overall plan for graduation with a faculty member while you have time to reflect and to plan. Students who want to take short-term classes (weekend classes) should pre-register at least 5 weeks before classes begin so that they can receive and complete their reading assignments in a timely manner. IV. DEGREE REQUIREMENTS All students are required to maintain at least a B (3.0) grade point average in their coursework. Moreover, students are allowed only two letter grades of C during their graduate studies. Students who receive a letter grade below C will be administratively withdrawn from the program. V. DEADLINES A. Receipt of applications for admission: To be considered for admission in the Fall semester, all application materials must be received by May 4 th (for the Fall 2012 semester only). Future application deadlines will be different. B. There are several deadlines that must be met in regards to graduation. Even when stated otherwise, it is the student's responsibility to see that all forms are filed and all deadlines are met. Students may obtain a copy of graduation deadlines for the semester in which the will graduate from the University Registrar s Office. Students must regularly check their Washburn for important announcements from the university. VI. FINANCIAL AID Most degree-seeking (unconditionally admitted) students qualify for some type of 6

7 financial aid. For information about financial aid, contacts the Financial Aid Office located in room 267 in Morgan Hall, or call the office at (785) WASHBURN UNIVERSITY EQUAL EDUCATIONAL OPPORTUNITY POLICY It is the traditional policy of Washburn University of Topeka to assure equal educational opportunity without regard to race, color, religion, age, national origin, ancestry, handicap, sex, marital or parental status. Equal educational opportunity includes (but is not limited to) admissions, recruitment, extracurricular programs and activities, housing, facilities use, access to course offerings, counseling and testing, financial aid, health services, employment, and athletics. Washburn University, incompliance with federal regulations, also commits itself to equal opportunities for the handicapped. The administration of Washburn University of Topeka is committed to its support of the principles of equal opportunity, and each unit within the University is charged with the Affirmative Action Plan. Responsibility for monitoring the implementation of this policy is delegated to the Affirmative Action Director, 375 A Morgan Hall, ; however, all management personnel will work to achieve these goals. 7

8 The Curriculum credit hours of required graduate level courses: Course Title Credit hours HS600 Integrative Human Services 3 *HS610 Professional Ethics and Practice 3 *HS640 Practicum 3 *HS695 Applied Research 3 *HS604 Advanced Methods of Individual Counseling 3 *HS605 Advanced Methods of Group Counseling 3 *HS615 Psychopharmacology 3 *HS635 Diagnosis of Substance Use Disorders 3 *HS641 Practicum 3 2. Additional required graduate level elective courses (Select 9 credit hours): Course Title Credit hours *HS620 Integrative Approaches to Dual Disorders 3 *HS625 Addiction and Recovery Services 3 *HS660 Clinical Supervision 3 **HS630 Lifespan Development 3 HS679 Narrative Practices 3 HS665 Integrative Residential Experience 3 Special Topic Seminars 3 * Graduate level courses required for those students seeking to become a Licensed Clinical Addiction Counselor (LCAC) under the State of Kansas Behavioral Sciences Regulatory Board (BSRB). The BSRB requires that half of the skills courses must be taken at the physical location of the institution. **Additional required courses in some state licensing programs (e.g., Oklahoma). Post-graduates of the MA in Human Services: In order to become a Licensed Clinical Addiction Counselor (LCAC) under the Kansas BSRB, you must pass an examination and complete a clinical supervision training plan that includes the following: hours over 2 years; 8

9 hours of the 4000 will be in direct client contact involving the diagnosis and treatment of substance abuse disorders; and hours of clinical supervision. COURSE DESCRIPTIONS: A: Required Courses (27 hours) 1. HS600 Integrative Human Services (3) This course presents the study of human services from a holistic perspective of understanding and working with people as whole individuals, including their physical, psychological, emotional, social, and spiritual aspects. This course also addresses the ecological context and healing effects of natural environments. Philosophies, values, and qualities associated with being an integrative helper will be covered as students learn the approaches that evidence consistency of theory and non-contradiction of methods. Students will be exposed to holistic approaches from Western and Eastern traditions. 2. *HS604 Advanced Methods of Individual Counseling (3) This course is designed to provide knowledge and practical skills in individual counseling. Students will learn a variety of techniques and strategies designed to facilitate educational and psycho-social development of clients. This course will include information on criteria for placement, stages of change, motivational interviewing methods, cognitive-behavioral strategies and other evidence-based, culturally sensitive approaches to individual counseling. 3. *HS605 Advanced Methods of Group Counseling (3) This course is designed to provide knowledge and practical skills in management of psycho-educational and therapeutic groups. Students will be learn a variety of techniques and strategies designed to facilitate educational and psycho-social development of groups of clients and significant others. This course will include information on criteria for cognitive-behavioral strategies and other evidence-based, culturally sensitive approaches to group counseling. 4. *HS610 Professional Ethics and Practice (3) This course covers major professional readiness issues, including code of ethics, privacy rights and confidentiality, legal responsibilities and liabilities of clinical supervision, and development of a professional attitude and identity. Cultural competence, professional organizations, and licensure and certification are also covered topics. 5. *HS615 Advanced Pharmacology and Substance Use Disorders (3) This course will address concepts of pharmacological properties and effects of psychoactive substances. The continuum of drug use will be discussed, such as initiation, intoxication, harmful use, abuse, dependence, withdrawal, craving, relapse, and recovery. Behavioral, psychological, social, and physical health effects of psychoactive substances, drug interactions, and medication-assisted therapies will be presented. 6. *HS635 Diagnosis of Substance Use Disorders (3) The course will cover diagnosis of substance use disorders, including the established diagnostic criteria for culturally sensitive screening, assessment, treatment planning, referrals, service coordination, 9

10 documentation, and consultation. The theories and principles that support the diagnosis and treatment of substance use disorders will be discussed, including indications and contraindications for use of each theory or technique, rationale for intervention, role of the counselor, and importance of incorporating gender and ethnicity in selecting and using assessment and treatment methods. 7. *HS640 Practicum (3) and 8. *HS641 Practicum (3) These courses will include a seminar and placement at an approved practicum site providing the opportunity for successful clinical practice of integrative services. Completion will include satisfactory evaluation by the practicum supervisor, fulfillment of seminar instructor course requirements, and at least 200 hours of supervised practice in each practicum. [For students pursuing licensure with the Kansas Behavioral Sciences Regulatory Board, the practica must be clinical experiences that integrate didactic learning supporting the diagnosis and treatment of substance use disorders with clinical experience; include at least 300 hours of client contact; and provide at least one hour of supervision for every 10 hours of client contact. Supervision shall be provided by the program s faculty and agency. 9. *HS695 Applied Research (3) This course covers the purposes and techniques of applied research, including qualitative and quantitative approaches. Topics to be discussed include research methodology, data analysis, computer research skills, critical evaluation of professional research reports, and practical application of research within cultural and historical context. B. ELECTIVES (SELECT 9 CREDIT HOURS) 1. *HS620 Integrative Approaches to Dual Disorders (3) This course will discuss the collaborative approaches of psychopharmacology, psycho education, supported employment, and culturally sensitive/ integrated/recovery-oriented substance use and mental health disorder treatment. 2. *HS625 Addiction and Recovery Services (3) This course will cover the holistic theories and models of treatment which include the philosophies, practices, policies and outcomes of the most generally accepted and evidence-based models of treatment, recovery, relapse prevention, and continuing care for addiction and other substancerelated problems. Students will consider the neurobiological, psychological, sociological, and spiritual theories of addiction and recovery, including theories necessary for social change related to addiction and recovery. An emphasis in the course will be given to recovery-oriented systems of care. 3. HS630 Lifespan Development (3) This course will focus on an integrative approach to wellness from before conception through the end of life. Students will learn about research-supported strategies for supporting biological, psychological, social, and spiritual health and well-being with a focus on meeting needs of the whole person throughout the lifespan. 10

11 4. *HS660 Clinical Supervision (3) This course will provide the knowledge and skills for successful clinical supervision of addiction counselors and staff. Clinical supervision tasks and functions will be discussed, including ability to assess development of competency; conduct of supervisory interviews; and design of professional development plans. 5. HS665 Integrative Residential Experience (3) This course offers students the opportunity to practice integrative approaches in a group setting. This is a 5-day residential that involves intense immersion in creative, expressive, service, and routine activities to enhance the experiential learning of students to incorporate these aspects into addiction counseling and other residential treatment facilities. 6. HS679 Narrative Practice (3) This course explores the approach of narrative practice as a tool for healing and teaching. Students will become familiar with the basic goals, concepts, and approaches of narrative practice, and the potential contributions of narrative practice to create change. Narrative practice includes using poetry, letter writing, storytelling, journaling, and more, as tools to promote healing, recovery and personal growth. Students will read and discuss the literature relating to narrative practice and will study the implications of the narrative perspective for counseling. They will learn about the application of narrative practice through classroom based experiential exercises and other assignments. Students will learn how narrative practice helps individuals and groups rewrite their stories to transform their lives. 7. HS685 Special Topic Seminars (3) Topics will vary from semester to semester and will be announced in advance. *Required courses for students seeking to become Licensed Clinical Addiction Counselors with the Kansas Behavioral Sciences Regulatory Board. 11

12 APPLICATION FOR ADMISSION TO MASTER OF ARTS IN HUMAN SERVICES EMPHASIS IN ADDICTION COUNSELING WASHBURN UNIVERSITY Return Completed Application To: Department of Human Services 311 Benton Hall Washburn University 1700 SW College Ave Topeka, KS

13 INSTRUCTIONS FOR COMPLETION APPLICATION FOR ADMISSION TO THE MASTER OF ARTS-HUMAN SERVICES PROGRAM WITH AN EMPHASIS IN ADDICTION COUNSELING 1. Apply to Washburn University at info/graduate-programs.html. 2. Complete all required pages of the enclosed Application for Admission to the Master of Arts in Human Services with an emphasis in Addiction Counseling Program. 3. Distribute the three reference forms to individuals whom you believe can attest to your ability to successfully complete a graduate program in human services (former professors are preferred). The reference form should be completed and placed in a sealed envelope. The person completing the reference form should sign across the seal and return it to the applicant. The three signed, sealed references should be submitted along with the other application materials. 4. Attach a typewritten biographical statement which briefly (one to two pages) discusses your interests related to human services, related experience, and why you want to pursue a Master s degree with an emphasis in addiction counseling. 5. Attach copies of transcripts of all undergraduate course work to this application. Original transcripts must be sent from the institutions in which the course work was completed to the Washburn University Admissions office. If all of your course work is from Washburn, submission of transcripts is not required to the Department or University. 6. Attach a $35.00 check for the non-refundable application fee to the packet submitted to the Human Services Department. Make check payable to Washburn University, with a notation that it is for MA in Human Services application fee. PLEASE NOTE: 1. Applicants will not be considered for admission to the Master of Arts in Human Services Program until all required application materials are received. 2. To be considered for Fall semester 2012 admission, all application materials must be received by Friday, May 4th. This includes all materials listed above. 13

14 APPLICATION FOR ADMISSION TO THE MASTER OF ARTS HUMAN SERVICES PROGRAM NAME: CURRENT ADDRESS: (First) (Middle) (Last) (Street) (City) (State) (Zip) PERMANENT ADDRESS: (Street) (City) (State) (Zip) TELEPHONE: ( ) ( ) Home Work address SOCIAL SECURITY NO: COUNTRY OF CITIZENSHIP: COLLEGES AND UNIVERSITIES ATTENDED: College/University Major Year Graduated Degree G.P.A. NOTE: Official transcripts of all previous college and university course work must be sent directly from each college/university to the Washburn Admissions Office, and copies of all transcripts must be attached to the application submitted to the Human Services Department. 14

15 THE THREE PERSONS WHO ARE SENDING REFERENCE FORMS FOR YOU: Name Title/Position Department/Agency/Institution EMPLOYMENT HISTORY (Last position first. If more space is needed, attach a resume): Position/Title Dates of Employment Agency Address Telephone Brief Description of Duties: Position/Title Dates of Employment Agency Address Telephone Brief Description of Duties: Position/Title Dates of Employment Agency Address Telephone Brief Description of Duties: 15

16 LIST SCHOLASTIC AND PROFESSIONAL AWARDS AND HONORS RECEIVED: LIST PROFESSIONAL AFFILIATIONS (including elected or appointed offices held): BRIEFLY DESCRIBE ANY VOLUNTEER EXPERIENCES AND/OR INVOLVEMENT IN COMMUNITY PROJECTS AND SERVICES: DO YOU PLAN TO BE A FULL-TIME STUDENT? (9 hours each semester; this is a program requirement) YES NO SEMESTER AND YEAR YOU WISH TO BE ADMITTED: AUTOBIOGRAPHICAL STATEMENT: Please attach a 1-2 page typewritten autobiographical statement. This statement should focus on a description of your experiences as they relate to your decision to pursue a graduate degree in human services with an emphasis in addiction counseling. You may choose to include information related to your work or educational experiences, your volunteer or extra-curricular activities, or your personal experiences. You should provide enough detail to help the admissions committee determine your readiness for entering the MA in Human Services Program with emphasis in addiction counseling at this time. A NON-REFUNDABLE APPLICATION FEE OF $35.00 MUST ACCOMPANY THIS APPLICATION. Make checks payable to Washburn University and make a notation on the check that this is for the MA in Human Services. 16

17 THIS APPLICATION INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. Signature Date RETURN COMPLETED APPLICATION MATERIALS TO: Department of Human Services 311 Benton Hall Washburn University 1700 S.W. College Ave Topeka, KS

18 This page is optional. It will be separated from your application form prior to review by the admissions committee. Name: Gender: Ethnic Group (Check one): ( ) Asian/Pacific Islander ( ) Mexican American ( ) Black or African American ( ) Other Hispanic ( ) Caucasian or Euro-American ( ) Native American ( ) Other 18

19 WASHBURN UNIVERSITY DEPARTMENT OF HUMAN SERVICES Reference Form for Master of Arts in Human Services Emphasis in Addiction Counseling Applicant: Please complete and sign the top section of this form prior to sending it to the individual selected to provide the reference. Name of person providing reference: The Family Educational Rights and Privacy Act and its amendments guarantee students access to their educational records. Students may, however, waive their right of access to references. The choice of the applicant regarding this reference is to be indicated below. Failure to sign will indicate acceptance of limited access. ( ) I do waive my right to inspect the contents of the following reference. ( ) I do not waive my right to inspect the contents of the following reference. Applicant s signature: Date: Statement concerning: (First Name) (Middle) (Last Name) who is applying for admission to the Master of Arts in Human Services Program with an emphasis in Addiction Counseling for the Semester of (year).... The following sections are to be completed by the person providing the reference. 1. How long and in what capacity have you known the applicant? 2. Please comment on any specific talents you have seen demonstrated by this applicant in working with people such as, completing tasks, dependability and other work related skills. (Attach additional pages if needed) 19

20 3. What is your estimate of the applicant s promise as a graduate student? (Intellectual independence, capacity for analytical thinking, ability to organize and express ideas clearly, scholarly and professional potential, etc.) Attach additional pages if needed. 4. In the table below, please rank the applicant s ability and professional competence in comparison to other individuals whom you have known at similar stages in their careers. General knowledge Selfreliance, Motivation Originality & creativity Emotional stability, maturity Ability to make decisions Writing skills Verbal skills Growth potential Skills in relating to others Cultural sensitivity Top 5% Superior Top 15% Excellent Top 25% Very Good Top 50% Average Lower 50% Below Average Unable to Rank 20

21 5. Please indicate your overall endorsement of the applicant: ( ) Highly Recommend ( ) Recommend ( ) Recommend with Reservation Reference Name: Position/Title: (Print) Address: (Agency/Institution) Signature: Date: Please return this reference to the applicant in a sealed envelope with your signature across the seal. 21

22 WASHBURN UNIVERSITY DEPARTMENT OF HUMAN SERVICES Reference Form for Master of Arts in Human Services Emphasis in Addiction Counseling Applicant: Please complete and sign the top section of this form prior to sending it to the individual selected to provide the reference. Name of person providing reference: The Family Educational Rights and Privacy Act and its amendments guarantee students access to their educational records. Students may, however, waive their right of access to references. The choice of the applicant regarding this reference is to be indicated below. Failure to sign will indicate acceptance of limited access. ( ) I do waive my right to inspect the contents of the following reference. ( ) I do not waive my right to inspect the contents of the following reference. Applicant s signature: Date: Statement concerning: (First Name) (Middle) (Last Name) who is applying for admission to the Master of Arts in Human Services Program with an emphasis in Addiction Counseling for the Semester of (year).... The following sections are to be completed by the person providing the reference. 1. How long and in what capacity have you known the applicant? 2. Please comment on any specific talents you have seen demonstrated by this applicant in working with people such as, completing tasks, dependability and other work related skills. (Attach additional pages if needed) 22

23 3. What is your estimate of the applicant s promise as a graduate student? (Intellectual independence, capacity for analytical thinking, ability to organize and express ideas clearly, scholarly and professional potential, etc.) Attach additional pages if needed. 4. In the table below, please rank the applicant s ability and professional competence in comparison to other individuals whom you have known at similar stages in their careers. General knowledge Selfreliance, Motivation Originality & creativity Emotional stability, maturity Ability to make decisions Writing skills Verbal skills Growth potential Skills in relating to others Cultural sensitivity Top 5% Superior Top 15% Excellent Top 25% Very Good Top 50% Average Lower 50% Below Average Unable to Rank 23

24 5. Please indicate your overall endorsement of the applicant: ( ) Highly Recommend ( ) Recommend ( ) Recommend with Reservation Reference Name: Position/Title: (Print) Address: (Agency/Institution) Signature: Date: Please return this reference to the applicant in a sealed envelope with your signature across the seal. 24

25 WASHBURN UNIVERSITY DEPARTMENT OF HUMAN SERVICES Reference Form for Master of Arts in Human Services Emphasis in Addiction Counseling Applicant: Please complete and sign the top section of this form prior to sending it to the individual selected to provide the reference. Name of person providing reference: The Family Educational Rights and Privacy Act and its amendments guarantee students access to their educational records. Students may, however, waive their right of access to references. The choice of the applicant regarding this reference is to be indicated below. Failure to sign will indicate acceptance of limited access. ( ) I do waive my right to inspect the contents of the following reference. ( ) I do not waive my right to inspect the contents of the following reference. Applicant s signature: Date: Statement concerning: (First Name) (Middle) (Last Name) who is applying for admission to the Master of Arts in Human Services Program with an emphasis in Addiction Counseling for the Semester of (year).... The following sections are to be completed by the person providing the reference. 1. How long and in what capacity have you known the applicant? 2. Please comment on any specific talents you have seen demonstrated by this applicant in working with people such as, completing tasks, dependability and other work related skills. (Attach additional pages if needed) 25

26 3. What is your estimate of the applicant s promise as a graduate student? (Intellectual independence, capacity for analytical thinking, ability to organize and express ideas clearly, scholarly and professional potential, etc.) Attach additional pages if needed. 4. In the table below, please rank the applicant s ability and professional competence in comparison to other individuals whom you have known at similar stages in their careers. General knowledge Selfreliance, Motivation Originality & creativity Emotional stability, maturity Ability to make decisions Writing skills Verbal skills Growth potential Skills in relating to others Cultural sensitivity Top 5% Superior Top 15% Excellent Top 25% Very Good Top 50% Average Lower 50% Below Average Unable to Rank 26

27 5. Please indicate your overall endorsement of the applicant: ( ) Highly Recommend ( ) Recommend ( ) Recommend with Reservation Reference Name: Position/Title: (Print) Address: (Agency/Institution) Signature: Date: Please return this reference to the applicant in a sealed envelope with your signature across the seal. 27