Application Supplement

Name:                                                                           

 1.      Send a Curriculum Vita with your supplemental application. Include:  a section listing any research/ statistics courses that you have taken.

 2.      Description of Previous Program

Respond to the following items to describe the education and training experiences from your previous degree program. 

      a.   Type of Degree: Bachelor's              Master's                       

      b.   Major:                                                                                 

      c.   Date of Degree:                                                                  

      d.   Degree From:                                                                      

      e.   Do you anticipate receiving your master's degree in the near
            future?    YES           NO         

      f.    Expected Date of Degree:                                                    

      g.   Degree From:                                                                         

      h.   If you have or will receive a master's degree, specify (circle)
            the type of program:  

              Mental health counseling           College student affairs

              Counseling psychology              School counseling

              Clinical psychology                   Other:                                

      i.    Are/Will you be a graduate of a U.S. CACREP-approved
             program?    YES           NO         

      j.    Did/Will you complete an honor's project or master's thesis? 
                                          

      k.  Title and Advisor/Supervisor                                                    

       l.    Type and hours of clinical (e.g., counseling) experience attained in degree program:                                            

      m.  Are /Will you be certified or licensed for clinical work? 
           YES           NO         

      n.   Title of other credentials (e.g., NBCC certified; LMHC): 
                                                                                                 

 3.     For each of he following items, please submit a
         one-page, typed, double spaced response to describe
         your training, experience, and goals. Please note, not all
           questions in the supplemental application will apply to everyone. 

     a.   Describe your Research-Related Skills and Interests. 
  (One page, double-spaced). 

      b.   Describe your Counseling-Related  Skills and Experience,
including client populations, your theoretical orientation,
special skills, supervision.   (One page, double-spaced).   

      c.   Describe your Teaching-Related Experience, including
student populations, philosophy of teaching, what 
you've learned from teaching. (One page, double-spaced).  

      d.   Description of Training and Professional Goals, including all
items below, as appropriate. (One or two pages, double-spaced).  

            1.   Why you wish to be trained as a scientist-practitioner.  

            2.   Why you wish to be trained as a counseling psychologist
in a College of Education.  

            3.   Why you wish to attend this counseling psychology program, include, if applicable, (a) the faculty member(s) with whom you would prefer to work and why and (b) the research agenda you aspire to pursue during your doctoral program.  

            4.   Any life experiences you have had, either personal or professional, that you believe distinguish you from other applicants.   

ATTENTION ALL APPLICANTS: Your typed responses should not exceed 5 double-spaced pages using one-inch margins and 12-point font. All items may not apply to all applicants. 

Please return the copy to:  Office of Graduate Studies, BRNG, Room 6104, 100 N. University, West Lafayette, IN  47907-2098, or email the copy to education-gradoffice@purdue.edu