Doctoral Program in School and Clinical Child Psychology Supplementary Application Form

Please print off, fill out and submit with the general department application checklist and other supporting documents.

Name: _____________________________________________________________________________

A. Undergraduate Degree: ___________________________ University: _________________________

GPA (last 60 credits* of undergraduate coursework): _________________________________________
GPA (all undergraduate psychology courses): _______________________________________________
Number of credits of psychology courses completed: _________________________________________

B. Master's Degree: ________________________________ Specialty: ___________________________
University: __________________________________________________________________________
GPA (graduate coursework): ____________________________________________________________

Characteristics of Master's program (check all that apply):

1. offered by a recognized degree-granting institution
2. identified as intended to educate and train counselling or school psychologists
3. the majority of faculty were psychologists
4. required enrolment for the equivalent of two full-time academic years

Note: If you have not obtained a graduate degree from a program that obviously meets the above 4 characteristics, but are of the opinion that you have completed the equivalent of such a program, please provide supporting documentation (e.g., institutional catalogues and brochures).

C. Half-year graduate course or six credits of senior undergraduate coursework in each of the following four areas:

1. Biological Bases of Behaviour

 University                      

 Graduate/
Undergradate 

 Year  
 Course No.  Credits
   Course Title                       
           
           
           

2. Cognitive-Affective Bases of Behaviour

 University                      

 Graduate/
Undergradate 

 Year  
 Course No.  Credits
   Course Title                       
           
           
           

3. Social Bases of Behaviour

 University                      

 Graduate/
Undergradate 

 Year  
 Course No.  Credits
   Course Title                       
           
           
           

4. Individual Differences

 University                      

 Graduate/
Undergradate 

 Year  
 Course No.  Credits
   Course Title                       
           
           
           

D. Completed at least:

1. Two courses in psychometrics and/or psychological assessment

 University                      
 Year  
 Course No.  Credits
Course Title                              
         
         

2. One half-year course in scientific and professional ethics

 University                      
 Year  
 Course No.  Credits
Course Title                              
         
         

3. One half-year course in research methods

 University                      
 Year  
 Course No.  Credits
Course Title                              
         
         

4. One half-year course in intervention or consultation

 University                      
 Year  
 Course No.  Credits
Course Title                              
         
         

E. Please describe on an attached page how and when you completed a minimum of 500 hours of supervised experience in psychological assessement and any other school psychology related experience you may have.  Be specific about start and end dates, name of placement or agency, the nature of clientele and client concerns dealt with, number of hours spent in client contact, number of hours of supervision received, name(s) of supervisor(s), etc.

 

The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act to determine eligibility for admission to a course or courses in the Department of Educational Psychology.  Questions regarding the collection or use or disclosure of this information should be addressed to the Associate Chair, Department of Educational Psychology, Room 6-102 Education North, University of Alberta, Edmonton, AB, T6G 2G5, Phone: (780) 492-5245.