CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS COLLEGE OF PROFESSIONAL STUDIES SCHOOL OF HEALTH AND HUMAN SERVICES

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1 CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS COLLEGE OF PROFESSIONAL STUDIES SCHOOL OF HEALTH AND HUMAN SERVICES MASTERS IN SCIENCE MARITAL AND FAMILY THERAPY PROGRAM 1000 E. Victoria Street Carson, Ca APPLICATION FOR ADMISSION TO THE MASTER S PROGRAM Note: RETURN THIS APPLICATION AND ALL ATTACHMENTS TO MASTERS OF SCIENCE IN MARITAL AND FAMILY THERAPY IN PERSON OR BY MAIL. No later than February 1, to begin classes in the Fall Semester and November 1, to begin classes in the Spring Semester. SUBMIT A COMPLETE APPLICATION PACKET. AN INCOMPLETE APPLICATION PACKET WILL RESULT IN DENIAL OF ADMISSION DUE TO MISSING INFORMATION ADMISSION INTO THE MASTERS OF SCIENCE IN MARITAL AND FAMILY THERAPY PROGRAM IS CONTINGENT UPON REVIEW AND ACCEPTANCE OF YOUR APPLICATION BY THE PROGRAM FACULTY ADMISSIONS COMMITTEE. APPLICANTS MUST ALSO COMPLETE AND SUBMIT A SEPARATE UNIVERSITY APPLICATION TO THE UNIVERSITY OFFICE OF ADMISSIONS. APPLICANTS MUST BE ADMITTED BY THE UNIVERSITY, THE COLLEGE, AND THE MARITAL AND FAMILY THERAPY PROGRAM TO BEGIN THE MASTER S PROGRAM IN MARITAL AND FAMILY THERAPY PLEASE TYPE OR PRINT LEGIBLY I. PERSONAL INFORMATION NAME: Last First Middle Social Security Number: Mailing Address: Street Address City State Zip Code PhoneNumber:( ) Address Citizenship Status: ( ) U.S. Citizen ( ) Permanent U.S. Resident ( ) International Student Have you ever been convicted of a felony of moral turpitude including a DUI (even if expunged)? ( ) Yes ( ) No

2 TOEFL SCORE (if international student) II. Educational History Please list all institutions attended, major area, dates attended, and degree(s) awarded. List the most recent institution first. Institution Dates Attended From To mm/yr mm/yy Major Degree Awarded Overall undergraduate Grade Point Average (GPA) (Submit transcript with this application) GPA in last 90 units of undergraduate work HONORS AND ACTIVITIES Extracurricular Activities (College, Business, Church or Community) Special Recognition (Offices held, organizational membership, etc.)

3 Scholarships/Fellowships/Awards Scholarship Year Received Amount Awarded Work or volunteer experience related to your career objective OPTIONAL INFORMATION Ethnic Identity: ( ) Non-Hispanic Caucasian ( ) Filipino ( ) Non-Hispanic Black ( ) Vietnamese ( ) Mexican-American ( ) Korean ( ) Puerto Rican ( ) Pacific Islander ( ) Cuban ( ) Asian-Indian ( ) Japanese ( ) Native American ( ) Chinese ( ) Other (Please Specify)

4 IV. AUTOBIOGRAPHICAL ESSAY Please prepare a word document essay (New Times Roman or Cambria 14 point font double spaced approximately 900 words) addressing: (1) elements of your educational and/or personal experience that have contributed to your interest in pursuing graduate study and to your motivation determination to succeed in it, (2) your interest and knowledge of the field of Marital and Family, (3) your career objective(s) and the abilities and skills you possess that will enhance your chances of success and (4) your other areas of interest V. WRITING SAMPLE Instructions: One of the important skills of an educated individual is the ability to write clearly and coherently. In order to assess this skill, each applicant to the graduate program in Marital and Family is asked to respond to one of the following questions. Your response should be not more than 900 words (New Times Roman or Cambria 14 point font double spaced) and should reflect your own honest work. Please attach your writing sample to the application. Choose one of the following questions to answer. Please note that some questions may not be relevant to your personal or professional experience. Choose a question that is relevant to your experience and interests. 1. As a person working with Marriages and Family concerns, or planning to work with marriages and families, what will you do to help them appreciate the differences and similarities about themselves and others? 2. Analyze the following quotation. What interpretation do you have and how does the question relate to the development of the individual in a Marriage or a Family? Come to the edge, he said. They said, We are afraid. They came He pushed them. And they flew. Apollinaire 3. What do you think is meant by the following statement? The truest test of intelligence is not how much we know what to do, but how we behave when we don t know what to do. Do you have any first-hand experiences that might illustrate this axiom? 4. What are the most pressing issues facing families and couples today?

5 III. LETTERS OF RECOMMENDATION Please arrange for three letters of recommendation, at least two of which must be from a University or College professor, who can attest to your ability to perform at the graduate level. Your application will not be processed without the letters of recommendation. State the name, title and affiliation of those who will be submitting letters on your behalf. Please print or type. 1. Name Title Affiliation 2. Name Title Affiliation 3. Name Title Affiliation Please prepare stamped and addressed envelopes for your recommenders. Recommendation forms should be sent to: ATTENTION: Department of Marital and Family California State University Dominguez Hills College of Health, Human Services, & Nursing 1000 E. Victoria Street Carson, CA

6 CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS MARITAL AND FAMILY THERAPY MASTERS PROGRAM LETTER OF RECOMMENDATION This part is to be completed by the applicant. Name Last First MI Social Security Number Applicant for: Spring / Fall Year APPLICANT STATEMENT I understand this letter of evaluation is to be received and maintained in confidence by California State University, Dominguez Hills Marital and Family Program for acceptance in the Masters of Science in Marital and Family Program. I hereby expressly waive any and all right I might have of access to this evaluation under the Family Education Rights and Privacy Act of I understand that the rights that I am waiving include, but are not limited to; the right to inspect and review this letter made for my use; the right to inspect and review the letter, their right to have a copy of this letter made for use; the right to request an amendment to this letter. ( ) I AGREE to waive access to this state from (Name of Recommender): ( ) I DO NOT AGREE to waive access to this statement from (Name of Recommender): Signature of Applicant Date PLEASE MAIL OR GIVE THIS FORM AND APPROPRIATLEY SELF-ADDRESSED STAMPED ENVELOPES TO YOUR RECOMMENDERS.

7 RECOMMENDATION FOR ADMISSION TO THE MASTER S PROGRAM IN MARITAL AND FAMILY THERAPY TO THE RECOMMENDER: Ms./Mr. is applying for admission to the Master of Science Program in Marital and Family. We are interested in your personal impression of the applicant s intellectual ability, ability in critical thinking and/or professional skills. Please comment on his/her characteristic, quality of previous work and potential for productive scholarship. Also, add a short one page verification that you are the applicant's reference. This part to be completed by the recommender. Please rank the candidate according to the students you have known over your career. Student Skill or Ability 1% 5% 10% 20% Lower Ability to Succeed in Graduate Work Ability to Write at the Graduate Level Ability to Think and Write Critically Creativity Commitment to Marital and Family Understanding of Marital and Family Ability to research a topic and write a report or essay on the topic Ability to Think Logically Cannot Assess Ability to Work with Others Overall Ranking of Candidate How long have you known the applicant? In what capacity have you know the applicant? Please add any additional comments on this form (on the reverse side) or attach a separate letter. Thank you for your cooperation. Name of Recommender Title/Position Phone Number Name of Institution/Agency Signature Date RECOMMENDER-PLEASE MAIL TO: Marital and Family Program Director California State University Dominguez Hills College of Health, Human Services, & Nursing E. Victoria Street Carson, CA

8 CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS MARITAL AND FAMILY THERAPY MASTERS PROGRAM LETTER OF RECOMMENDATION This part is to be completed by the applicant. Name Last First MI Social Security Number Applicant for: Spring / Fall Year APPLICANT STATEMENT I understand this letter of evaluation is to be received and maintained in confidence by California State University, Dominguez Hills Marital and Family Program for acceptance in the Masters of Science in Marital and Family Program. I hereby expressly waive any and all right I might have of access to this evaluation under the Family Education Rights and Privacy Act of I understand that the rights that I am waiving include, but are not limited to; the right to inspect and review this letter made for my use; the right to inspect and review the letter, their right to have a copy of this letter made for use; the right to request an amendment to this letter. ( ) I AGREE to waive access to this state from (Name of Recommender): ( ) I DO NOT AGREE to waive access to this statement from (Name of Recommender): Signature of Applicant Date Applicant: Please write your name on the other side of this form before giving it to the recommender. PLEASE MAIL OR GIVE THIS FORM AND APPROPRIATLEY SELF-ADDRESSED STAMPED ENVELOPES TO YOUR RECOMMENDERS.

9 RECOMMENDATION FOR ADMISSION TO THE MASTER S PROGRAM IN MARITAL AND FAMILY THERAPY TO THE RECOMMENDER: Ms./Mr. is applying for admission to the Master of Science Program in Marital and Family. We are interested in your personal impression of the applicant s intellectual ability, ability in critical thinking and/or professional skills. Please comment on his/her characteristic, quality of previous work and potential for productive scholarship. Also, add a short one page verification that you are the applicant's reference. This part to be completed by the recommender. Please rank the candidate according to the students you have known over your career. Student Skill or Ability 1% 5% 10% 20% Lower Ability to Succeed in Graduate Work Ability to Write at the Graduate Level Ability to Think and Write Critically Creativity Commitment to Marital and Family Understanding of Marital and Family Ability to research a topic and write a report or essay on the topic Ability to Think Logically Cannot Assess Ability to Work with Others Overall Ranking of Candidate How long have you known the applicant? In what capacity have you know the applicant? Please add any additional comments on this form (on the reverse side) or attach a separate letter. Thank you for your cooperation. Name of Recommender Title/Position Phone Number Name of Institution/Agency Signature Date RECOMMENDER-PLEASE MAIL TO: Marital and Family Program Director California State University Dominguez Hills College of Health, Human Services, & Nursing 1000 E. Victoria Street. Carson, CA

10 CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS MARITAL AND FAMILY THERAPY MASTERS PROGRAM LETTER OF RECOMMENDATION This part is to be completed by the applicant. Name Last First MI Social Security Number Applicant for: Spring / Fall Year APPLICANT STATEMENT I understand this letter of evaluation is to be received and maintained in confidence by California State University, Dominguez Hills Marital and Family Program for acceptance in the Masters of Science in Marital and Family Program. I hereby expressly waive any and all right I might have of access to this evaluation under the Family Education Rights and Privacy Act of I understand that the rights that I am waiving include, but are not limited to; the right to inspect and review this letter made for my use; the right to inspect and review the letter, their right to have a copy of this letter made for use; the right to request an amendment to this letter. ( ) I AGREE to waive access to this state from (Name of Recommender): ( ) I DO NOT AGREE to waive access to this statement from (Name of Recommender): Signature of Applicant Date PLEASE MAIL OR GIVE THIS FORM AND APPROPRIATLEY SELF-ADDRESSED STAMPED ENVELOPES TO YOUR RECOMMENDERS.

11 RECOMMENDATION FOR ADMISSION TO THE MASTER S PROGRAM IN MARITAL AND FAMILY THERAPY TO THE RECOMMENDER: Ms./Mr. is applying for admission to the Master of Science Program in Marital and Family. We are interested in your personal impression of the applicant s intellectual ability, ability in critical thinking and/or professional skills. Please comment on his/her characteristic, quality of previous work and potential for productive scholarship. Also, add a short one page verification that you are the applicant's reference. This part to be completed by the recommender. Please rank the candidate according to the students you have known over your career. Student Skill or Ability 1% 5% 10% 20% Lower Ability to Succeed in Graduate Work Ability to Write at the Graduate Level Ability to Think and Write Critically Creativity Commitment to Marital and Family Understanding of Marital and Family Ability to research a topic and write a report or essay on the topic Ability to Think Logically Cannot Assess Ability to Work with Others Overall Ranking of Candidate How long have you known the applicant? In what capacity have you know the applicant? Please add any additional comments on this form (on the reverse side) or attach a separate letter. Thank you for your cooperation. Name of Recommender Title/Position Phone Number Name of Institution/Agency Signature Date RECOMMENDER-PLEASE MAIL TO: Marital and Family Program Director California State University Dominguez Hills College of Health, Human Services, & Nursing 1000 E. Victoria, Street Carson, CA