School Psychology Program G3 Canevin Hall Duquesne University 600 Forbes Avenue Pittsburgh, PA 15282

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1 General Instructions: With the exception of GRE scores, all application materials, including letters of reference that have been sealed and signed across the back, should be mailed in one package to: School Psychology Program G3 Canevin Hall Duquesne University 600 Forbes Avenue Pittsburgh, PA Applications must be postmarked by January 15. Incomplete applications will not be considered. Psy.D. School Psychology Program application packets must include: 1. Completed application form 2. Letter of interest: The letter of interest must describe your educational, research, and applied experiences that have prepared you for graduate education in School Psychology. Also, please explain how your career goals align with earning a Psy.D., a practiceoriented degree. 3. Official undergraduate and graduate transcripts: Transcripts must be obtained from your university's registrar s office. For admission to the School of Education at Duquesne University, students must have an overall minimum GPA of 3.0 on a 4 point scale. 4. Three letters of recommendation: Each applicant must submit three letters of recommendation focusing on their personal, professional, and/or academic qualifications. Letters should be returned to you in a sealed envelope and signed across the back flap in order to be included in a single application packet. 5. Application fee: If the online School of Education application is completed PRIOR to mailing this School Psychology Program application, there is no application fee. Otherwise, a $50.00 nonrefundable service fee payable to Duquesne University must accompany this application. 6. Graduate Record Examination (GRE) results Results of the GRE will be submitted directly to the University. The institution code for Duquesne University is R2196, major code Information on the GRE can be found at Please supply your GRE results on this application as well as having the official copy send to our program. GRE RESULTS MUST BE RECEIVED BY January 15 th deadline. Confirmation: A confirmation will be sent to the address you provide on the application form once all of your application materials have been received.

2 PSYD SCHOOL PSYCHOLOGY PROGRAM APPLICATION FOR ADMISSION Date of Application Social Security Number Name of Applicant Current Address Number and Street City/State/Zip Country Current Telephone Work Telephone Cell Number Permanent Address Number and Street City/State/Zip Country Permanent Telephone Fax Number address Mailing address (Where you want correspondence sent): current address permanent address Country of Citizenship Certifications or Licenses held Relevant Employment History Company Dates of Employment Position Academic Record List in chronological order ALL colleges and universities attended, including professional schools. College/University Dates of Attendance Degree Major GPA 2

3 Awards, Scholarships, or other relevant honors or activities: Graduate Record Examination The Graduate Record Examination (GRE) is required for all applicants to the Ph.D., Psy.D., and CAGS programs. GRE results must be received by the January 15th deadline, therefore, students are encouraged to schedule the exam early in order to assure that their scores are received by the deadline. I have taken GRE (date) Verbal Quantitative Analytical Writing I plan to take the GRE on (date) Recommendations Please list below the names and addresses of the three persons from whom you have requested letters of recommendation. These letters should be included in the single application packet International Students Country of Citizenship Place of Birth Duquesne University requires submission of TOEFL or IELTS scores for all non-native English speaking applicants. Scores must be current to within one year of application. The Duquesne University TOEFL institution code is The University requires the following minimum scores in each area to be considered for admission: TOEFL: a minimum of 80 on the Internet-based Test (ibt) with no sub-score less than 17, or 550 on the paper-based test IELTS: a minimum of 6.5 with no sub-score less than 6.5 (reading), 5.5 (writing), 5.5 (speaking), 6.0 (listening). Have you taken the TOEFL test? Yes No If yes, on what date? TOEFL score: If no, when do you plan to take the TOEFL? Have you taken the IELTS test? Yes No If yes, on what date? IELTS score: If no, when do you plan to take the IELTS? 3

4 Demographic Information (Optional) Date of Birth Gender: Male Female What is your racial/ethnic background? American Indian or Alaska Native Asian Black/African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White/Caucasian Other How did you learn about our school psychology programs? Check all that apply. From a friend NASP publication/website A school psychologist Other A Duquesne University student, alumni, or employee Print publication on graduate school programs Gradschools.com Have you ever been convicted, pled guilty or no contest (nolo contendere) to a crime other than a summary traffic offense? o Yes (If yes, attach a separate sheet and describe in full detail.) o No Are there any criminal charges presently pending against you other than a summary traffic offense? o Yes (If yes, attach a separate sheet and describe in full detail.) o No I certify that I have given accurately and completely the information requested by this application and that I am not withholding information which should be known. Signature of Applicant Date Notice of Nondiscrimination and Nonharassment Policy Duquesne University, motivated by its Catholic identity, values equality of opportunity, human dignity, racial, cultural and ethnic diversity, both as an educational institution and as an employer. Accordingly, the University prohibits and does not engage in discrimination or harassment on the basis of race, color, religion, national origin, sex, age, disability or status as a veteran or disabled veteran. Further, Duquesne University will continue to take affirmative steps to support and advance these values consistent with the University's mission statement. This policy applies to all programs and activities of the University, including, but not limited to, admission and employment practices, educational policies, scholarship and loan programs and athletic or other University-sponsored programs. This is a commitment by the University in accordance with its religious values and applicable federal, state and local laws and regulations. Nothing herein, however, should be interpreted as a waiver by the University of its own Constitutional and legal rights based upon its religious affiliation. The person responsible for coordinating its efforts under this policy is Dr. Judith Griggs, Affirmative Action Officer, room S-1, Assumption Hall, university extension Revised: 9/ Application Revised 04/2013 4

5 LETTER OF RECOMMENDATION Applicant name: Address: Telephone number : This letter of recommendation is intended to support the applicant s application for graduate study. Under the provisions of the Family Educational Rights and Privacy Act (FERPA), the applicant has the right to retain or waive access to this reference. Applicant, please check one of the boxes below. I DO give up the right of access to this reference letter. I DO NOT give up the right of access to this reference letter. Applicant signature: Date: Reference writer, please attach your letter of recommendation to this form and return both to the applicant in a sealed envelope with your signature across the seal. I, the reference writer, submit this statement to the School Psychology Program at Duquesne University in full accord with the conditions set forth above. Signature: Date: Print name: Position: Address: Telephone number: 5

6 LETTER OF RECOMMENDATION Applicant name: Address: Telephone number : This letter of recommendation is intended to support the applicant s application for graduate study. Under the provisions of the Family Educational Rights and Privacy Act (FERPA), the applicant has the right to retain or waive access to this reference. Applicant, please check one of the boxes below. I DO give up the right of access to this reference letter. I DO NOT give up the right of access to this reference letter. Applicant signature: Date: Reference writer, please attach your letter of recommendation to this form and return both to the applicant in a sealed envelope with your signature across the seal. I, the reference writer, submit this statement to the School Psychology Program at Duquesne University in full accord with the conditions set forth above. Signature: Date: Print name: Position: Address: Telephone number: 6

7 LETTER OF RECOMMENDATION Applicant name: Address: Telephone number : This letter of recommendation is intended to support the applicant s application for graduate study. Under the provisions of the Family Educational Rights and Privacy Act (FERPA), the applicant has the right to retain or waive access to this reference. Applicant, please check one of the boxes below. I DO give up the right of access to this reference letter. I DO NOT give up the right of access to this reference letter. Applicant signature: Date: Reference writer, please attach your letter of recommendation to this form and return both to the applicant in a sealed envelope with your signature across the seal. I, the reference writer, submit this statement to the School Psychology Program at Duquesne University in full accord with the conditions set forth above. Signature: Date: Print name: Position: Address: Telephone number: 7