UNIVERSITY OF MARYLAND

Counseling Psychology Graduate Program

Counseling Application Extra Section

(You must copy this form and paste it into a word processing program so that you can complete it and send it in with your application.  Please type all your responses.)

Name:  __________________________________________________________
 

Email address:  ____________________________________________________
 

Contact information of someone who can ALWAYS reach you:

           Name:________________________________________

           Phone #:______________________________________
 

Permanent address: ___________________________________________________
 
 

PART I: EXPERIENCES





A. COURSEWORK  (Note: all questions relating to GPA should be answered using a 4.0 GPA scale.)
 

         1) List all psychology undergraduate courses you have completed, specifying statistics courses with an asterick (*).
 

Course Title

Credits 

College/University Where Taken

Final Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total # undergraduate psychology credit hours: _______          Cumulative psychology GPA : _______


 
 

          2) List all psychology-related graduate courses that you have completed, specifying statistics courses with an asterisk (*).
 

Course Title

Credits

College/University Where Taken

Final Grade

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total # graduate credit hours: ___________          Cumulative Graduate GPA: ____________


 

B. RESEARCH
 

          1) Describe your research experiences.
 

               a.  undergraduate research:
 
 
 

               b. post-B.A./B.S. research:
 
 
 

          2) List the titles of any research papers presented at professional meetings or published.  If the papers were published, note the issue # and title of the journal in which it appeared.
 
 
 
 
 
 

          3) Have you completed an undergraduate honors thesis?      Yes______     No______
 

                    Was it data-based?          Yes______    No______
 

                    Did it include a statistical analysis?          Yes______    No______
 

                    Title:
 
 
 
 

            4) Have you completed a master’s thesis?          Yes ______     No _______
 

                     Was it data-based?           Yes_______     No_______
 

                     Did it include a statistical analysis?         Yes_______      No_______
 

                     Title:
 
 
 

C.  TEACHING EXPERIENCES:  Describe any relevant teaching experiences, including teaching assistantships.  Include where these experiences took place and the nature of the supervision you received.
 

      1) Undergraduate:
 
 
 

      2) Post-B.A./B.S.:
 
 
 

D.  COUNSELING EXPERIENCES:  Describe any relevant counseling experiences, including formal practica.  Include where these experiences took and describe the nature of the supervision you received.
 
 
 
 
 

F.  BACKGROUND EXPERIENCES:  Is there anything else in your background and pursuits – physical, cultural, motivational, or scholastic – that you believe is relevant to our evaluation of your application?  If so, please explain.
 
 



PART II: GOALS

Use a separate piece of paper to answer these questions.

A.  Career Goals:  Describe your career goals.
 
 

B.  Professional Identity:  Why do you want to be a counseling psychologist?
 
 

C.  Program Choice: Why have you chosen University of Maryland’s counseling psychology program?  What aspects of the program will be most useful to you?
 
 

D.  Research Interests: Describe your current research interests and relate them to the research of 1-2 faculty members in University of Maryland’s Counseling Psychology Program.  How well do your research interests “fit” those of the program?