UDM Psychology Summer Enrichment Program Application 2014

Page One

Psychology Summer Enrichment Program

Program Dates: May 19- June 27, 2014

Please send letters of recommendation and offical transcripts from each institution you attended to:
University of Detroit Mercy
Doctoral Program in Clinical Psychology
ATTN: Barry Dauphin, Ph.D.
Director of Clinical Training
4001 W. McNichols Ave.
Detroit, MI 48221

The application should take approximately 20-45 minutes to complete. You will not be able to "Save & Continue", so you will need to complete the application in one session. To help prepare your answers, you can download the application from the website first at the following link: http://liberalarts.udmercy.edu/programs/depts/psychology/graduate/pycphd/Enrichment/index.htm Click the "How to Apply" Link.

PROGRAM QUALIFICATIONS

• Be a U.S. citizen or U.S. national with appropriate documentation
• Have completed at least 2 years of college as demonstrated on official transcript
• Demonstrate an interest in pursuing a graduate degree in the Behavioral Health field such as Clinical Psychology, Social Work, Counseling, etc.
• Self-identify with an economically disadvantaged status based upon financial guidelines provided in application, or educationally disadvantaged status based on the definitions outlined in the application

1. First Name: *This question is required.

Last Name:
First Name:
Middle Name or Initial:

2. Date Of Birth *This question is required.

calendar

3. Social Security Number (xxx-xx-xxxx): *This question is required.

4. Gender: *This question is required.

5. Current Mailing Address: *This question is required.

Street
City
State
Zip code

6. I will be at this current address until: *This question is required.

calendar

7. Current Phone Number (xxx-xxx-xxxx): *This question is required.

8. email address *This question is required.

9. Permanent Mailing Address: *This question is required.

Street
City
State
Zip code

10. Permanent Phone Number: *This question is required.

11. What city & state are you originally from? *This question is required.

City
State

12. Citizenship *This question is required.

If you are not a US citizen Proof of residency is required (i.e. driver’s license, passport or immigration card)

13. Do you have any Physical Disabilities that necessitate specially designed instructional materials or programs, modified physical facilities, or related services to enable full participation in and access to the program? If yes, please specify. *This question is required.

Please enter an 'other' value for this selection.