COUNSELOR EDUCATION GRADUATE PROGRAMS Department Application Form for Ph.D. in Education with Concentration in Counselor Education

Transcription

1 COUNSELOR EDUCATION GRADUATE COUNSELOR EDUCATION GRADUATE PROGRAMS Department Application Form for Ph.D. in Education with Concentration in Counselor Education Name Current Address Application Date Phone Number City State Zip Home/Permanent Address Phone Number City State Zip College(s) Attended I. SCHOLASTIC RECORD Name/Location Dates Attended Major Degree Earned Undergraduate Graduate If your work for the Master's degree was done in the College of Education and Human Services at this university, please indicate the month and year in which you took the Master's comprehensive examination. / Please provide other evidence of scholastic achievements (e.g., scholarships, fellowships, membership in honorary and professional societies or fraternities).

2 I.A. PREREQUISITE DEGREE/COURSES The required doctoral program course work builds on a master s program accredited by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) and covers all doctoral content areas identified by CACREP Standards. Prerequisites may be required if the Master s degree obtained is not compliant with or equivalent to the current Master s CACREP standards. Do you hold a master s degree from a CACREP accredited master s program? q YES or q NO If YES, list the specialty area and graduation date /. If NO, please identify on your transcript(s) the graduate courses successfully competed (including credit hours) in the following topic areas (from the core curriculum standards for CACREP accredited master s programs). Topic Institution Course Number/Name/Credit Hours Professional Orientation & Ethical Practice Year Grade Social & Cultural Diversity Human Growth & Development Career Development Helping Relationships Group Work Assessment Research & Program Evaluation Clinical Instruction 2 of 5

3 II. RESEARCH AND PUBLICATIONS A. Master's Level Research 1.Title of thesis or research project/paper 2.Name of Professor by whom directed B. Professional publications (please provide APA style reference and a brief description) Ill. PROFESSIONAL EXPERIENCE IN TEACHING, COUNSELING, ADMINISTRATION AND OTHER WORK IN SCHOOLS, COLLEGES, MILITARY SERVICE, AND PUBLIC AGENCIES A. Teaching Experience Type of School Name of School/Institution Grades/Subject Number of (e.g., elem, HS, Years Taught military) B. Non-Teaching Professional Experience Agency/Institution Location Type of Service Number of Years Employed 3 of 5

4 IV. ATTIITUDE, PURPOSE AND AMBITION Why are you interested in Counselor Education and Supervision as a career? What are your plans after completing your education? A. Teaching? B. Research? C. Technical or professional? What do you consider to be the chief strengths and weaknesses in your training and background? 4 of 5

5 V. REFERENCES AND ADDITIONAL COMMENTS Please provide the names and addresses for the three references that will be providing your letters of reference. 1. Name 2. Name 3. Name To complete your program application, please provide the following either by paper or electronic copy: Resumé or Curriculum Vitae Official transcripts from all colleges/universities attended (staff can download SIU Carbondale transcripts) Three letters of reference Official Graduate Record Exam (GRE) scores A five page, double-spaced essay addressing your career goals and views on personal and professional growth A copy of your master s thesis, research paper, or final project Application for admission to graduate study through the Graduate School To return this completed form as a written document, please print and send/fax it to: Graduate Secretary, Department of Educational Psychology & Special Education, 625 Wham Drive MC 4618, Southern Illinois University, Carbondale, IL Fax: 618/ To send this document electronically, click on >> SEND (Revised: June 2015) 5 of 5