DEPARTMENT OF PSYCHOLOGY / DEPARTEMENT SIELKUNDE

DEPARTMENT OF PSYCHOLOGY / DEPARTEMENT SIELKUNDE Master s Programme in Clinical and Counselling Psychology Magisterprogram in Kliniese- en Voorligtingsielkunde Dear Applicant Thank you for your interest in furthering your studies at the University of the Free State, and in particular at the Department of Psychology. The attainment of a qualification in Clinical or Counselling Psychology will enable you to follow a career in professional psychology. The integrated programme offered in this department aims at preparing you academically, personally and professionally for such a career. We trust that you will find all the necessary information in this application. Please contact us if you require any assistance with the application process. Geagte Aansoeker ------- Baie dankie dat u dit oorweeg om verder aan die Universiteit van die Vrystaat, en in besonder die Departement Sielkunde, te studeer. Die verwerwing van n kwalifikasie in Kliniese- of Voorligtingsielkunde sal u in staat stel om n loopbaan te volg as professionele sielkundige. Die geïntegreerde program wat in hierdie departement aangebied word, is daarop gemik om u op akademiese, persoonlike en professionele vlak daarvoor toe te rus. Ons vertrou dat u al die nodige inligting in hierdie aansoekpakket sal vind. Kontak ons gerus indien u hulp met die aansoekproses verlang. Dr Lindi Nel Me Elize du Plessis Programme coordinator Programme administrator Programkoördineerder Programadministrateur Tel: 051-401 2732 Tel: 051-401 9420 nelli@ufs.ac.za duplesse@ufs.ac.za 1

CONFIDENTIAL Application for admission to the Master s Programme in Clinical and Counselling Psychology PLEASE NOTE: Students who want to be considered for the selection process must carefully study the following information and submit the necessary documentation to the Department accordingly. THIS APPLICATION PACKAGE CONSISTS OF THREE SECTIONS SECTION A Master s Application Form To be completed by ALL applicants SECTION B DV3 Registration Form To be completed ONLY by UFS students who are registered at the University of the Free State in 2016 for honours in Psychology SECTION C * DV1: Application for Admission to the UFS To be completed by ALL OTHER applicants, AS WELL AS UFS students who are not registered at the UFS in 2016. * IMPORTANT: The DV1 application for admission form is available from the UFS website - www.ufs.ac.za See the heading STUDENTS click on UFS application forms. Students who need to complete the DV1 form (Application for Admission to the UFS) should note the following banking details (this is also set out on the DV1 form): Please send the complete application to: Bank ABSA Brandwag Account Number 1570 850 071 Branch Code 630 734 / Electronic transfers: 632005 Reference ID number Amount As indicated on the form POSTAL ADDRESS: Mrs. Elize du Plessis Department of Psychology Internal Box 40 University of the Free State PO Box 339 BLOEMFONTEIN, 9300 Telephone: (051) 401 9420 E-mail: duplesse@ufs.ac.za PHYSICAL ADDRESS: Mrs. Elize du Plessis Department of Psychology Psychology Building Room 202 University of the Free State Nelson Mandela Avenue BLOEMFONTEIN, 9301 Telephone: (051) 401 9420 Incomplete documents received after the closing date of 3 June 2016, will not be considered. 2

VERTROULIK Aansoek vir toelating tot die Magisterprogram in Kliniese- en Voorligtingsielkunde LET WEL: Studente wat vir die keuringsproses in aanmerking wil kom, moet die onderstaande inligting noukeurig bestudeer en hiervolgens die nodige dokumentasie aan die Departement voorlê. HIERDIE AANSOEKPAKKET BESTAAN UIT DRIE AFDELINGS: AFDELING A Magisteraansoekvorm Word deur ALLE aansoekers voltooi. AFDELING B DV3-registrasievorm Word SLEGS deur UV-studente wat in 2016 vir honneurs aan die Univ van die Vrystaat geregistreer is, voltooi. AFDELING C * DV1: Aansoek om toelating tot die UV Word deur ALLE ANDER aansoekers, ASOOK UV-studente wat nie gedurende 2016 aan die UV geregistreer is nie, voltooi. * BELANGRIK: Hierdie DV1-aansoekvorm is verkrygbaar van die UV-webblad www.ufs.ac.za sien onder die hofie STUDENTE kliek op UV-aansoekvorms. Studente wat die DV1-vorm (Aansoek om toelating tot die UV) voltooi, moet let op die volgende bankbesonderhede (dit is ook in die DV1-vorm uiteengesit): Bank ABSA Brandwag Rekeningnommer 1570 850 071 Takkode 630 734 / Elektroniese oorplasings: 632005 Verwysing: ID-nommer Bedrag: Soos aangedui op vorm Stuur asseblief die volledige aansoek aan: POSADRES: Mev. Elize du Plessis Departement Sielkunde Interne Posbus 40 Universiteit van die Vrystaat Posbus 339 BLOEMFONTEIN, 9300 Telefoon: (051) 401 9420 Epos: duplesse@ufs.ac.za FISIESE ADRES: Mev. Elize du Plessis Departement Sielkunde, Sielkundegebou Kamer 202 Universiteit van die Vrystaat Nelson Mandelarylaan BLOEMFONTEIN, 9301 Telefoon: (051) 401 9420 Onvolledige dokumente wat na die sluitingsdatum van 3 Junie 2016 ontvang word, sal nie oorweeg word nie. 3

DEPARTMENT OF PSYCHOLOGY / DEPARTEMENT SIELKUNDE Master s Programme in Clinical and Counselling Psychology / Magisterprogram in Kliniese- en Voorligtingsielkunde SECTION A / AFDELING A To be completed by ALL applicants / Word deur ALLE aansoekers voltooi Master s application form / Magisteraansoekvorm 4

Paste passport photograph here Plak paspoortfoto hier 1. IDENTIFYING PARTICULARS / IDENTIFISERENDE BESONDERHEDE: 1.1 1.2 1.3 Surname/ Van First names / Voorname ID number / Identiteitsnommer 1.4 Age / Ouderdom 1.5 Postal Address / Posadres 1.6 1.7 1.8 Telephone number / Telefoonnommer E-mail / E-pos Current occupation / Huidige beroep 1. 2. 1.9 Gender / Geslag Male/ Manlik: Female / Vroulik: 1.10 Ethnicity / Etnisiteit Asian / Asiaat: Black / Swart: Coloured / Kleurling: White / Wit: 1.11 Disabled / Gestremd Yes / Ja: No / Nee: 1.12 If you answered Yes to Question 1.11 please describe the nature of your disability / Indien u op Vraag 1.11 Ja geantwoord het, beskryf asb. die aard van u gestremdheid.... 5

1.13 In which category do you apply? / In watter kategorie doen u aansoek: CLINICAL / KLINIES COUNSELLING / VOORLIGTING IMPORTANT / BELANGRIK: MARK ONLY ONE AND MOTIVATE YOUR CHOICE: /Merk NET EEN EN MOTIVEER U KEUSE: Should you be selected in another category other than your first choice, would you still accept the position? / Indien u in n ander kategorie gekeur sou word, sou u steeds die posisie aanvaar? 1.14 Please indicate your language proficiency in terms of reading, writing, speech and comprehension. Refer to all the languages that you are proficient in. / Beskryf jou taalvaardighede in terme van lees, skryf, praat en verstaan. Verwys na al die tale wat u magtig is. YES / JA NO / NEE 2. ACADEMIC QUALIFICATIONS / AKADEMIESE KWALIFIKASIES: 2.1 Universities attended / Universiteite bygewoon: University / Universiteit Degree obtained / Graad behaal Year / Jaar 6

2.2 Undergraduate Psychology modules / Voorgraadse Sielkunde-modules: Complete the following table. This is compulsory. In addition, certified copies of academic records must be attached. Voltooi asseblief die onderstaande tabel. Dit is verpligtend. Daarbenewens moet gewaarmerkte afskrifte van simbolestate aangeheg word. University / Universiteit Degree / Graad Psychology Module name / Sielkunde Module naam Code / Kode Year / Jaar Final subject % Finale vak % 7

2.3 Postgraduate qualifications / Nagraadse Kwalifikasies: Complete the following table. This is compulsory. In addition, certified copies of academic records must be attached. PLEASE NOTE: If you are currently busy with your postgraduate qualification and do not have any module marks available when completing this application, it is expected of you to send a certified copy of your half year marks to the Department as soon as possible, but not later than 18 July 2016. In this case the table below can be ignored. In addition page 14 of this application form should be completed when sending your mid-year marks. No application will be considered without these marks. Voltooi asseblief die onderstaande tabel. Dit is verpligtend. Daarbenewens moet gewaarmerkte afskrifte van simbolestate aangeheg word. LET WEL: Indien u tans besig is met u nagraadse kwalifikasie en ten tye van die aansoek geen beskikbare modulepunte het nie, word daar van u verwag om n gewaarmerkte afskrif van u halfjaarpunte so spoedig moontlik, maar nie later as 18 Julie 2016 aan die Departement te stuur. In hierdie geval kan die onderstaande tabel geïgnoreer word. Bladsy 14 van hierdie aansoekvorm moet egter voltooi word wanneer u u halfjaarpunte aanstuur. Geen aansoek sal oorweeg word sonder hierdie punte nie. University / Universiteit Degree / Graad Psychology Honours Module name / Sielkunde Honneurs Modulenaam Module Year/ Jaar Final subject %/ Finale vak % 8

3 (a) Autobiography / Outobiografie: The selection panel would like to get to know you as holistic individual. Illustrate your self-insight and write an autobiography in which you reflect on the positive, as well as negative experiences of your life. Take the selection criteria (academic potential and achievement, psychological knowledge and insight, work experience, community involvement, interpersonal skills, maturity and research skills) into account while sharing more about yourself with us. Please be truthful about any aspects which may prevent you from achieving success in the applied master s programme. Also ensure that the panel is informed about any aspects that make you a suitable and unique candidate. You are welcome to attach your answer on a loose page. Please limit your autobiography to a maximum of 1200 words. The autobiography may be typed. Die keuringspaneel wil jou graag as holistiese individu beter leer ken. Stel jou selfinsig ten toon en skryf n outobiografie waarin jy reflekteer oor die positiewe, sowel as negatiewe ervaringe van jou lewe. Neem die keuringskriteria (akademiese potensiaal en prestasie, sielkundige kennis en insig, werkservaring, gemeenskapsbetrokkenheid, interpersoonlike vaardighede, volwassenheid en navorsingsvaardighede) in ag, terwyl jy meer van jouself met ons deel. Indien enige, wees asseblief eerlik ten opsigte van aspekte wat jou moontlik kan verhinder om sukses te behaal in n toegepaste magistergraad. Maak ook seker dat die paneel bewus is van enige aspekte wat jou juis n unieke en geskikte kandidaat sal maak. Jy is welkom om jou antwoord op n los bladsy aan te heg. Beperk asseblief jou outobiografie tot n maksimum van 1200 woorde. Die outobiografie kan ook getik word. 9

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3 (b) Unique abilities / Unieke vermoëns: As psychologists in South Africa, we need to deliver services within a multicultural and diverse society. Use the space below to highlight your unique ability and competency in this regard. / As sielkundiges in Suid-Afrika, is dit nodig om dienste aan n multikulturele en diverse gemeenskap te lewer. Gebruik die spasie hieronder om jou unieke vermoëns en bevoegdheid in hierdie verband aan te dui. 12

4. Although it is not a requirement of the University of the Free State to submit referee reports, we do require the names of two people who will be able to verify certain information should it be necessary. Alhoewel dit nie n vereiste van die Universiteit van die Vrystaat is dat u referentvorms moet inhandig nie, vereis ons wel dat u die name van twee persone verskaf wat gepaste inligting van u kan verifieer en wie gekontak kan word, indien nodig. 1. Name of person / Naam van persoon Relationship / Verwantskap Number of years known / Aantal jare ken Telephone number / Telefoonnommer 2. Naam van persoon / Name of person Relationship / Verwantskap Number of years known / Aantal jare ken Telephone number / Telefoonnommer 5. Feedback / Terugvoer: The Department strictly adheres to procedures when selecting the new intake of students. The decision of the Department with regard to the success of an application is final and binding. If your application was unsuccessful, no correspondence will be entered into by the Department with any associates, family members or acquintances whatsoever. Upon completion of both the paper selection and interview processes each prospective candidate will receive an official email with the final result. This will serve at the only form of feedback. Die Departement volg streng prosedures met keuring van nuwe studente. Die besluit van die Departement met betrekking tot die sukses van n aansoek is finaal en bindend. Indien u aansoek onsuksesvol is, sal daar geensins verder met belanghebbendes, familielede of vriende gekorrespondeer word nie. Na voltooiing van die papierkeuring en die onderhoude sal elke voornemende kandidaat n amptelike epos met die finale uitslag ontvang. Dit sal as die enigste vorm van terugvoer dien. 13

2.3 Postgraduate qualifications (Module marks not available by 3 June 2016) Nagraadse Kwalifikasies (Modulepunte nie beskikbaar teen 3 Junie 2016) PLEASE NOTE: This table is only completed if you are currently busy with your postgraduate qualification and do not have any module marks available when completing the application. The table below is sent to the Department as soon as possible, but not later than 18 July 2016 together with a certified copy of your midyear marks. No application will be considered without these marks. LET WEL: Hierdie tabel word slegs voltooi indien u tans besig is met u nagraadse kwalifikasie en ten tye van die aansoek geen beskikbare modulepunte het nie. Die onderstaande tabel word so spoedig moontlik, maar nie later as 18 Julie 2016, saam met ʼn gewaarmerkte afskrif van u halfjaarpunte aan die Departement gestuur. Geen aansoek sal oorweeg word sonder hierdie punte nie. NAME & SURNAME / NAAM & VAN: ATTENTION / VIR AANDAG: Ms Elize du Plessis Master s selection / Magisterkeuring Fax number / Faksnommer: (051) 401 3556 E-mail / E-pos: duplesse@ufs.ac.za COMPLETE THE FOLLOWING TABEL / VOLTOOI DIE ONDERSTAANDE TABEL: University / Universiteit Degree / Graad Honours modules / Honneursmodules Code / Kode Year/ Jaar Subject percentage / Vakpersentasie 14

DEPARTMENT OF PSYCHOLOGY / DEPARTEMENT SIELKUNDE CONSENT FORM / TOESTEMMINGSVORM I / Ek Surname / Van Name / Naam 1. Give consent to participate in the selection procedure for the Master s programme in Clinical and Counselling Psychology offered by the University of the Free State. Stem in om deel te neem aan die keuringsprosedure vir die Magisterprogram in Kliniese- en Voorligtingsielkunde wat deur die Universiteit van die Vrystaat aangebied word. 2. Understand and accept the following: a. The reasons for the selection procedure; b. The criteria employed during the selection procedure; c. The nature of the selection procedure; d. How the decisions of the selection panel will be implemented. e. The decision of the panel is final. Verstaan en aanvaar die volgende: a. Die redes vir die keuringsprosedure; b. Die keuringskriteria wat toegepas word tydens die keuringsprosedure; c. Die aard van die keuringsprosedure; d. Hoe die besluite van die keuringspaneel geïmplemeteer sal word. e. Die keuringspaneel se besluit is finaal. 3. Understand and accept that it is my responsibility to: a. Bring barriers to learning 1 to the attention of the Department before the selection procedure commences; b. Ensure that I submit complete and accurate application documents. 1 Barriers to learning include (but are not limited to) the following: concentration, eyesight, hearing, language problems (comprehension, reading, spelling, writing), motor problems, symptoms of medical illnesses, side-effects of medication, consequences of recent hospitalisation or psychological/psychiatric problems. 15

Verstaan en aanvaar dat dit my verantwoordelikheid is om: a. Hindernisse tot leer 2 onder die Departement se aandag te bring voordat die keuringsprosedure ʼn aanvang neem; b. Toe te sien dat my aansoekpakket volledig en akkuraat ingedien word. 4. Am aware that I may contact Mrs. Elize du Plessis at 051-401 9420; or e-mail: duplesse@ufs.ac.za to verify the completeness of my application documents. Is bewus daarvan dat ek die volledigheid van my aansoekpakket kan nagaan deur met Mev. Elize du Plessis te kontak by tel.nr. 051-401 9420 of e-pos: duplesse@ufs.ac.za 5. Give permission that personal information as provided by me, may be made available to the members of the selection panel. Gee toestemming dat persoonlike inligting wat deur my voorsien word, beskikbaar gestel word aan die keuringspaneel. 6. Accept that the Department is unable to explain all aspects of the selection procedure before the procedure commences. Aanvaar dat die Departement nie alle aspekte van die keuringsprosedure kan verduidelik voordat die prosedure n aanvang neem nie. 7. I hereby declare that all information provided in this application is correct and truthful. Ek verklaar hiermee dat al die inligting op hierdie aansoekvorm juis en korrek is. / HANDTEKENING / SIGNATURE: DATUM / DATE: / / 2016 2 Hindernisse tot leer sluit die volgende in (maar is nie beperk tot die voorbeelde wat volg nie): gehoor, konsentrasie, sig, taalprobleme (begrip, lees, spel, skryf), mediese siektesimptome, motoriese probleme, newe-effekte van medikasie, gevolge van onlangse hospitalisering, of sielkundige/psigiatriese probleme. 16

CHECK LIST / MERKLYS IMPORTANT: Please consult the checklist of this application package to ensure a complete application. BELANGRIK: Maak seker dat u die merklys van hierdie aansoekpakket deurgaan ten einde u van die volledigheid van die aansoek te vergewis. A COMPLETE APPLICATION MUST INCLUDE THE FOLLOWING / N VOLLEDIGE AANSOEK MOET DIE VOLGENDE BEVAT: 1. Master s application form / Magisteraansoekvorm 2. 3. Certified copies of degree certificates and academic records (If you are currently busy with your postgraduate qualification and do not yet have this information available, please send it before 18 July 2016.) Gewaarmerkte afskrifte van graad- en simbolestate (Indien hierdie inligting nog nie beskikbaar is nie omdat u tans met u nagraadse kwalifikasie besig is, stuur dit asb. voor 18 Julie 2016.) DV3: Completed by current 2016 UFS honours in Psychology students Voltooi deur huidige 2016 UV-Sielkunde-honneursstudente OR / OF DV1: All other students, as well as UFS students not registered at the UFS in 2016 Alle ander studente, asook UV-studente wat NIE gedurende 2016 aan die UV geregistreer is nie IMPORTANT DATES / BELANGRIKE DATUMS: CLOSING DATE / SLUITINGSDATUM: 3 JUNE / JUNIE 2016 SUBMISSION OF FINAL MARKS / INDIENING VAN FINALE PUNTE: 18 JULY / JULIE 2016 RESULTS OF PAPERSELECTION / PAPIERKEURING UITSLAE BESKIKBAAR: 27 JULY / JULIE 2016 SELECTION WEEK / KEURINGSWEEK: 22-26 AUGUST / AUGUSTUS 2016 17

SECTION B / AFDELING B To be completed ONLY by UFS students who are registered at the University of the Free State in 2016 for honours in Psychology. Word SLEGS deur UV-studente wat in 2016 vir honneurs in Sielkunde aan die Universiteit van die Vrystaat geregistreer is, voltooi. DV3 Registration form / DV3-registrasievorm 18

UNIVERSITEIT VAN DIE VRYSTAAT UNIVERSITY OF THE FREE STATE DV3 APPLICATION FORM FOR REGISTERED STUDENTS IN THEIR FINAL YEAR WHO WISH TO APPLY FOR A NEW QUALIFICATION ON COMPLETION OF THE QUALIFICATION (DEGREE / DIPLOMA / CERTIFICATE) THEY ARE CURRENTLY REGISTERED FOR. AANSOEKVORM VIR GEREGISTREERDE STUDENTE IN HUL FINALE JAAR WAT VIR N NUWE KWALIFIKASIE WIL AANSOEK DOEN NA VOLTOOIING VAN DIE HUIDIGE KWALIFIKASIE (GRAAD / DIPLOMA / SERTIFIKAAT) WAARMEE HULLE TANS BESIG IS. STUDENT NUMBER STUDENTENOMMER: 20.. ID or PASSPORT NO: ID of PASPOORTNR: Title: Initials: Surname: Titel: Voorletters: Van: Postal address: Posadres: Postal code: Poskode: Telephone numbers: Telefoonnommers: Dialing code: Skakelkode: Number: Nommer: Home / Huis: Work / Werk: Cell phone number / Selfoonnommer: New qualification for which you wish to register on completion of your current qualification Postgraduate. Die nuwe kwalifikasie waarvoor u na voltooiing van u huidige kwalifikasie wil registreer Nagraads Please indicate Dui asseblief aan: UNDERGRADUATE VOORGRAADS POSTGRADUATE NAGRAADS HEALTH SCIENCES UNDERGRADUATE GESONDHEIDSWETENSKAPPE VOORGRAADS HEALTH SCIENCES POSTGRADUATE GESONDHEIDSWETENKSAPE NAGRAADS New Qualification: Nuwe kwalifikasie: New Qualification code: Nuwe Kwalifikasiekode: Campus where classes sessions will be attended Die kampus waar u klasse / werksessies sal bywoon Student s signature: Date: Handtekening van student: Datum: Approval by Programme Director / Head of the Department after checking whether the student complies with all the prerequisites for admission to the apecific qualification: Goedkeuring deur Programdirekteur / Departementshoof nadat gekontroleer is of die student aan al die voorvereistes vir toelating to tdie spesifieke kwalifikasie voldoen: Signature: Date: Handtekening Datum: Pers.Number, Initials and Surname: Pers.nommer, Voorletters en Van: 19

SECTION C / AFDELING C To be completed by ALL OTHER applicants, AS WELL AS UFS students who are NOT registered at the UFS in 2016. Word deur ALLE ANDER aansoekers, ASOOK UV-studente wat NIE gedurende 2016 aan die UV geregistreer is nie, voltooi. DV1 Application for Admission to the UFS/ Aansoek om toelating tot die UV * IMPORTANT: This DV1 Application for Admission form is available from the UFS website - www.ufs.ac.za See the heading STUDENTS click on UFS application forms. Alternatively, a hard copy of this form is obtainable from the Information Office at Thakaneng Bridge, UFS. * BELANGRIK: Hierdie DV1-Aansoekvorm vir Toelating is verkrygbaar van die UV-webblad www.ufs.ac.za sien onder die hofie STUDENTE kliek op UVaansoekvorms. Alternatiewelik kan n harde kopie van die vorm by die Inligtingskantoor op Thakaneng Brug, UV, bekom word. 20