APPLICATION FOR 2019 MA (CLINICAL PSYCHOLOGY)

Transcription

1 UNIVERSITY OF JOHANNESBURG DEPARTMENT OF PSYCHOLOGY Please attach photo here SECTION A BIOGRAPHICAL PARTICULARS Full Application form must be TYPED and not HANDWRITTEN APPLICATION FOR 2019 MA (CLINICAL PSYCHOLOGY) UJ Reference/student number (COMPULSORY) Title Initials Surname First name ID number Age Nationality With which population group do you identify? (For statistical purposes) Tick one please Black Coloured Indian White Asian Other If you answered Other in the above question, please clarify Cellular phone number address Postal address Postal code 1

2 Language proficiency Poor Average Good English Afrikaans African language (specify) Other (specify) Languages Marital status Married Partnered Single Divorced Number of dependent children SECTION B PERSONAL PARTICULARS Briefly list any hobbies, sport activities and interests. Write a brief essay about your life history (to fit into approximately 1 page). 2

3 CAREER EXPECTATIONS Where do you want to work after registering as a psychologist? Private practice Institutional/ Hospital Corporate environment Other Please motivate and elaborate on your response above. Unsure 3

4 What is your view of being a clinical psychologist in the South African context? RESEARCH INTERESTS Outline the area/s of psychology in which you wish to conduct research in the form of a minor dissertation. Refer to the research problem/s, specific research questions and relevant research method/s. FIELD RELATED EXPERIENCE Specify and describe any mental health related community work, or professional/clinical experience, if any, that you have been involved in (e.g. volunteer work, child care, youth work, psychometric training). You may also indicate to what extent you have had experience in working with people (e.g. employment, societies) and in which contexts. 4

5 Specify and describe any research-related activities, if any, you were involved in. 5

6 SECTION C ACADEMIC INFORMATION CERTIFIED COPIES OF UNIVERSITY ACADEMIC RECORD AND/OR PROGRESS REPORT MUST BE PROVIDED WITH THIS APPLICATION PLEASE DO NOT INCLUDE ANY DOCUMENTS THAT ARE NOT REQUESTED Where did you matriculate? In what year? Where did you complete Psychology III? In what year? Semester 1 (%) Semester 2 (%) Final 3 rd year results (compulsory) Where are you registered for / where did you complete your honours degree in Psychology? In what year? Honours subjects Final Year result (%) Or Provisional Term result (%) if you are still completing Honours 6

7 Please provide the title of the research project you have completed / are busy completing during Honours Are you currently registered for (or have you already completed) your master s degree in Psychology? If yes, at which university? When? Title of dissertation Supervisor Final mark (if available) 7

8 SECTION D CAREER INFORMATION Briefly list your career experience. Period Position Employer Full / Part time SECTION E SELECTION INFORMATION List the universities (including University of Johannesburg) where you have already applied for selection for a specific course as well as when and for which categories. Year University Category 8

9 SECTION F REFEREE FORM Please provide the particulars of your referee. Title, surname and initials Capacity Address Telephone numbers Work Cell NB. Referee reports are to be completed and sent to the selection address by the referees themselves NOT by the applicant. 9

10 SECTION G DECLARATION FOR SUBMISSION OF APPLICATION I (full name/s): agree to comply with the selection process as stipulated in the application guide. Confirm that all the information that I have provided in this application form as well as in all the supporting documentation is true and without alteration. Signed: Date: This application form, together with an administrative fee of R250 must be returned to the following address on or before 13 July 2018 (BEFORE 12:00PM) Selection: MA (Clinical Psychology) / Anita Smyth University of Johannesburg Department of Psychology - APK C-Ring 415 Kingsway Campus Cnr Kingsway & University Rd Auckland Park 2006 NB: NO LATE / INCOMPLETE APPLICATIONS WILL BE ACCEPTED NOT attaching your Academic record and/or progress report will be considered as an incomplete application 10

11 ADDITIONAL INFORMATION THE FOLLOWING INFORMATION IS IMPORTANT FOR US IN ORDER TO ENSURE THAT YOUR APPLICATION RUNS SMOOTHLY: 1. Applications can be couriered or submitted personally to the Department of Psychology. Please refer to the application guide to see when the forms can be submitted personally. 2. Your proof of payment for the administration fee of R250 needs to accompany your application form. 3. Electronic transfers or direct bank deposits only please. 4. NO cheques, cash or postal orders will be accepted. Bank: ABSA Name of Beneficiary: UJ Psychology Account Number: Type of Account: Cheque Account Branch: Auckland Park Branch Code: PLEASE NOTE: A reference for your deposit is compulsory. NB: Please use the following reference only: Please DO NOT bind your document. 6. Admin application fee cannot be refunded. NB: NO LATE / INCOMPLETE APPLICATIONS WILL BE ACCEPTED NOT attaching your Academic record and/or progress report will be considered as an incomplete application 11

12 CHECK LIST I (full name/s): Confirm that all the information that I have provided in this application form as well as in all the supporting documentation is true and without alteration. Signed ; Date : 1. Online application complete (Please provide UJ student number) 2. Completed Hard copy of application form (Printed and signed); 3. Attached ALL certified academic records and/or progress reports; 4. Attached proof of payment NB: NO LATE / INCOMPLETE APPLICATIONS WILL BE ACCEPTED NOT attaching your Academic record and/or progress report will be considered as an incomplete application 12