APPLICATION FOR ADMISSION
DOCTOR OF PSYCHOLOGY (PSY.D.) PROGRAM IN SCHOOL PSYCHOLOGY
Psychology Department
Minnesota State University, Mankato
Name:
Date:
Street Address:
City:
State, ZIP:
Phone:
Email:
Alternate or Home Address:
City:
State, ZIP:
Phone:
Name and address of someone who is most likely to know your address seven years from now:
Name
Address
Phone
Graduate Record Exams
(Most recent scores)
Date of Examination:
Sum of V + Q:
Verbal Aptitude Test:
Quantitative Aptitude Test:
Analytic Aptitude Test:
Academic Background
Institution
Dates
Degree
Major
Minor
Psychology Coursework: Please record all coursework in psychology that you have taken or
will have completed before beginning your graduate training. Attach additional page if
necessary.
Course
Year Taken
School
Hours
Grade
Education Coursework: Please record all coursework in education that you have taken or will
have completed before beginning your graduate training. Attach additional page if necessary.
Course
Year Taken
School
Hours
Grade
Grade Point Average: Please list your undergraduate grade point averages as indicated:
Overall GPA:
Last Two Years:
Psychology GPA:
What, if any, special circumstances regarding your GPA should be considered?
References
Name
Institution
Phone Number
1.
2.
3.
I certify that the information given on this application is complete and accurate.
Signature ____________________________________
Date
__________________
This form should be sent to:
School Psychology Psy.D. Admissions Committee,
Psychology Department
Armstrong Hall 23
Minnesota State University
Mankato, MN 56001
Please include the following in your program application:
1. This completed program application
2. Curriculum vita or resume
3. Three Letters of Reference
4. Personal Statement that preferably includes the following:
a. Reason for interest in MSU, Mankato’s Psy.D. program
b. Research interests
c. Professional interests
5. Writing sample and/or peer reviewed publications (or submissions)
Reminder: Applicants must complete the separate application for the College of Graduate
Studies.