PsyD Supplemental Personal Data Form

The following information is required for applicants to the Graduate School of Professional Psychology PsyD program. Please complete all sections and attach any additional sheets.

Name: _______________________________________________________________________

Entry year for which you are applying: 20_____

GRE Psychology Subject Test Score: __________

(Taking this test is optional.)

On what specialty to you think you will focus while at GSPP? ____________________________________________________________________________________________________________________________________________________________

What are your current plans for financial support while at GSPP? ____________________________________________________________________________________________________________________________________________________________

Below are the recommended prerequisite courses for the PsyD program. If you have a degree in psychology, please indicate such. If you do not have a degree in psychology, but have/will have completed the prerequisite courses, please list how you will have met the requirement of four (4) psychology courses before September of your intended admission year. If the title of the course you have taken is not the same as the one listed, please include a syllabus for the course you have taken.

I have a Bachelor?s degree in Psychology. ______

I have a Master?s degree in Psychology. ________

I received a score of 660 or higher on the GRE Psychology Subject test._____

I do not have a degree in Psychology, but have taken the courses below:

	School	Qtr/Sem/Yr	Course #	Title
Abnormal Psychology
Child Psychology
Experimental Psychology
Personality Theory
Statistics

PsyD Supplemental Data Form

Page 2

Please list the names of those providing your letters of reference:

1. _________________________________________________________________________________________________________________________________________________________________________________________
2. _________________________________________________________________________________________________________________________________________________________________________________________
3. _________________________________________________________________________________________________________________________________________________________________________________________

Please list any institution from which you have received a degree along with your GPA from that institution:

Institution

Degree

Major

GPA

List employment and volunteer work relevant to the clinical practice of professional psychology, even if you have enclosed a vita or resume that lists work experience:

Employer

Your Title

Type of Work

Dates

Hrs/Wk

Paid or Volunteer

List relevant research experience you have had, even if you have included this information on your vita or resume:

Employer

Your Title

Type of Work

Dates

Hrs/Wk

Paid or Volunteer

PLEASE NOTE: An in-person interview in Denver is REQUIRED of all final applicants to the PsyD program. Interviewees will be notified by phone and/or mail.