SCHOOL OF SOCIAL SCIENCES

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1 SCHOOL OF SOCIAL SCIENCES DISCIPLINE OF PSYCHOLOGY MASTERS PROGRAMME CLINICAL PSYCHOLOGY : 2016 PROSPECTIVE CANDIDATES ARE INVITED TO APPLY FOR ADMISSION TO THE ABOVE PROGRAMME. APPLICATION FORMS MAY BE REQUESTED FROM: DR M.B SETWABA (COURSE COORDINATOR) UNIVERSITY OF LIMPOPO (TURFLOOP CAMPUS) DEPARTMENT OF PSYCHOLOGY PRIVATE BAG X1106 SOVENGA 0720 TEL: (015) WEBSITE: COMPLETED APPLICATION FORMS MUST BE SUBMITTED TO REACH THE DEPARTMENT BY 31 JULY ED APPLICATIONS WONT BE ACCEPTED, ONLY REFEREES REPORT TO BE SENT VIA . COMPLETED FORMS SHOULD BE HAND DELIVERED OR SENT VIA POST. LATE APPLICATIONS WILL NOT BE CONSIDERED. INTERVIEWS OF THE SHORT-LISTED CANDIDATES WILL TAKE PLACE DURING AUGUST APPLICATION WITHOUT PASSPORT PHOTO WILL NOT BE CONSIDERED. 1

2 Dear Applicant Thank you for showing interest in our master s programme in Clinical Psychology at the University of Limpopo. Kindly send at your earliest convenience not later than 31 July 2015, the following information together with your completed application forms (hereto attached). An updated curriculum vitae Your biographical information: *this should be about two typed A4 pages double or one and half spacing. *it should include strong and weak personal attributes, a major crisis you encountered in life and how you dealt with it. *why you want to become a Clinical Psychologist A certified copy of the original academic record Certified copies of your degree certificates and identity document. Referees reports: these should be sent separately, by your referees directly to us, by the 31 st of July 2015 ( address : Your completed forms together with this information will help us make a short list to be made available before the interviews are held. You will be notified after this date if you have made the short list or not. We are looking forward to meeting you, should you be short listed. Signed Dr M.B Setwaba (Coordinator: Masters Clinical Training) 2

3 STRICTLY CONFIDENTIAL PASSPORT PHOTO COMPULSORY UNIVERSITY OF LIMPOPO SCHOOL OF SOCIAL SCIENCES DISCIPLINE OF PSYCHOLOGY APPLICATIONS FOR ADMISSION: 2016 M.A (CLINICAL PSYCHOLOGY) PLEASE COMPLETE THE ATTACHED APPLICATION FORM IN FULL 1. PERSONAL INFORMATION SURNAME.TITLE FIRST NAMES AGE SEX.DATE OF BIRTH STUDENT NUMBER (only applicable to UL students) MARITAL STATUS TELEPHONE NUMBER (H) (W) . RESIDENTIAL ADDRESS POSTAL ADDRESS ACADEMIC RECORD: 2.1 MATRICULATION: YEAR SCHOOL.. 3

4 (Attach certified copies of results/symbols) SUBJECTS AND SYMBOLS: UNIVERSITY QUALIFICATIONS (Attach certified copies and academic record) DEG/DIPLOMA INSTITUTION YEAR OF REGISTRATION YEAR OBTAINED 2.3 If you are presently enrolled for Honours, please mention the university concerned and expected date of completion 2.4 OTHER QUALIFICATIONS: 3. OTHER PROFESSIONAL OR APPROPRIATE EXPERIENCE: (Mention any other relevant experience in psychology and/or membership of association in this discipline, or experience which You consider to have been meaningful in the formation of your character). 4. SCHOLARSHIPS OR BURSARIES RECEIVED: 4

5 5. LANGUAGE ABILITY: LANGUAGE POOR GOOD VERY GOOD AFRIKAANS: Speak ENGLISH: Speak N.SOTHO: Speak TSHIVENDA: Speak XITSONGA: Speak OTHER: SPECIFY. 6. STATE OF HEALTH: 6.1 PHYSICAL WELL-BEING: Describe your present state of health and mention any physical factors that may be relevant in the evaluation of your application. 6.2 MENTAL HEALTH: Describe your present state of mental health. Mention any factors with regard to treatment Or medication that may be relevant to the evaluation of your application. 7. APPLICATIONS MADE TO UNIVERSITIES: 7.1 If you intend applying to any other university this year, mention it as well as the categories of applications. 7.2 have you ever submitted an application to this university? If so, for which course and which year?. 5

6 REFERENCES: Please select two referees who are able to submit comments about your suitability as a candidate for the course. Each referee must complete a form and return it to the Department of Psychology. Please ensure that your referees are willing to furnish the required information and that their reference forms reach the department. NB. No lecturer in the Department of Psychology at the University of Limpopo or any family member or friend can be selected as a referee. 1.1 Title, Initials & Surname:... Capacity:... Address:.... Postal Code:... Tel. No: Fax No: Title, Initials & Surname:... Capacity:... Address:.... Postal Code:... Tel No: Fax No: I hereby declare that the information provided in the application form is correct, and that no information has been purposely withheld SIGNATURE DATE 6

7 UNIVERSITY OF LIMPOPO SCHOOL OF SOCIAL SCIENCES DEPARTMENT OF PSYCHOLOGY REFEREES REPORT: MA (CLINICAL PSYCHOLOGY) COURSE Name of candidate The above mentioned candidate nominated you as a referee in an application for admission to the Master s Degree in Clinical Psychology. Kindly respond to the following questions and send the report at your earliest convenience to the following address on or before the 31 st July 2015 to the following address: 1. In what capacity has you know the applicant and for how long? In your opinion, how suitable is the candidate for this type of training? 3. What do you consider to be the candidate's strongest qualities?.... 7

8 4. What do you consider to be the candidate's major limitations?. Please rate the candidate on the following items as indicated in the table hereunder: Below Average Good Excellent Unable to judge 5. Intellectual ability Average 6. Research ability 7. Writing skills 8. Motivation 9. Resourcefulness and initiative 10. Perseverance 11. Adapting to new situations 12. Personal maturity 13. Co-operativeness 14. Openness to new ideas 15. Openness to critical feedback 16. Insight into own personality 17. Empathy 18. Interpersonal skills 19. What reservation might you have about the candidate training to become a clinical psychologist? 20. Please provide any additional information that would help evaluate the candidate... 8

9 Name of referee:... Title:... Position/Profession:... Address: Telephone Number: Signature Date Thank you for your co-operation. 9

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