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. 90707
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 IN COMPLETE APPLICATION PACKET
WILL RESULT IN DENIAL OF ACMISSION 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
Phone Number:__(______)_____________________________________________________________________________
Citizenship Status: ( ) U.S. Citizen ( ) Permanent U.S. Resident
( ) International Student
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.)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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
( ) Mexican-American
( ) Korean
( ) Cuban
( ) Asian-Indian
( ) Chinese
( ) Other _____________
( ) Non-Hispanic Black
( ) Puerto Rican
( ) Japanese
( ) Vietnamese
( ) Pacific Islander
( ) Native American
(Please Specify)
III.
LETTERS OF RECOMMENDATION
Please arrange for three letters of recommendation, at least one 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.
2.
3.
Name
Title
Affiliation
Name
Title
Affiliation
Name
Title
Affiliation
Please prepare stamped and addressed envelopes for your recommenders.
Recommendation forms should be sent to:
ATTENTION:
Masters of Science Marital and Family Therapy Program
California State University Dominguez Hills
College of Professional Studies
1000 E. Victoria Street
Carson, CA. 90747
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
Applicant for: Fall ________________
Year
___________________________________
Social Security Number
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 Therapy Program for
acceptance in the Masters of Science in Marital and Family Therapy 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 1974. 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 writhe 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.
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 Therapy. 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.
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
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
Therapy
Understanding of Marital and Family
Therapy
Ability to research a topic and write a
report or essay on the topic
Ability to Think Logically
Top
1%
Top
5%
Top
10%
Top
20%
Top
50%
Lower
50%
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 Therapy program director
College of Professional Studies
School of Health and Human Services
1000 E. Victoria Street
Carson, CA. 90747
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
Applicant for: Fall ________________
Year
___________________________________
Social Security Number
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 Therapy Program for
acceptance in the Masters of Science in Marital and Family Therapy 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 1974. 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 writhe 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.
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 Therapy. 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.
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
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
Therapy
Understanding of Marital and Family
Therapy
Ability to research a topic and write a
report or essay on the topic
Ability to Think Logically
Top
1%
Top
5%
Top
10%
Top
20%
Top
50%
Lower
50%
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 Therapy program director
College of Professional Studies
School of Health and Human Services
1000 E. Victoria Street
Carson, CA. 90747
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
Applicant for: Fall ________________
Year
___________________________________
Social Security Number
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 Therapy Program for
acceptance in the Masters of Science in Marital and Family Therapy 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 1974. 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 writhe 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.
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 Therapy. 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.
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
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
Therapy
Understanding of Marital and Family
Therapy
Ability to research a topic and write a
report or essay on the topic
Ability to Think Logically
Top
1%
Top
5%
Top
10%
Top
20%
Top
50%
Lower
50%
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 Therapy program director
College of Professional Studies
School of Health and Human Services
1000 E. Victoria Street
Carson, CA. 90747
IV.
V.
STATEMENT OR INTENT AND GOALS
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 Therapy, (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
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 Therapy 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 on of the following questions to answer. Please note that some questions
may not be relevant to your persona 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?