The document is an application for admission to the graduate psychology program at Western Michigan University. It requests information such as contact details, citizenship status, educational history, GRE scores, intended program of study, professional goals, and references. All application materials must be submitted by December 15 for admission consideration to programs beginning the following fall semester.

1. Department of Psychology Graduate Program
Application for Admission to the Department of Psychology Graduate Program
College of Arts & Sciences Western Michigan University
ALL application materials due by DECEMBER 15
APPLICANT INFORMATION. Enter full legal name for all Department and University records.
Last Name First Name Middle Name WIN: WMU Student Number
e-mail address: Former Name:
Optional:You are not required to provide this information *Note: Additional scholarship funds may be available for historically underrepresented groups.
Find information and online application forms at http://www.wmich.edu/grad/funding.html
Birth Date Gender Ethnic Group*
Country of Citizenship International Applicant-Visa Status
! US ! CANADA ! Permanent US Resident (alien) ! Student Visa ! Immigrant Visa
! Other (specify) ! Other (specify)
Current/Local Mailing Address (street, city, state, zip, country) Send mail to this Telephone
address until (date) (area code)
Permanent Home Mailing Address Send mail to this Telephone
address until (date) (area code)
LIST IN ORDER ALL COLLEGES OR UNIVERSITIES ATTENDED, regardless of length of time enrolled or number of credits
completed. Begin with the most recent enrollment, including those in which you are currently enrolled. (Attach an additional sheet if
necessary.) International Applicants: List the actual name of degree received or expected (do not translate into American
equivalent). You must also apply to International Student Services.
DATES DATE
NAME OF INSTITUTION LOCATION ATTENDED DEGREE Received/ GPA
MAJOR
Official Transcripts from ALL City, State, OPTIONAL or Diploma Expected do not
institutions must be sent to both Country From Received OPTIONAL round up
Admissions and Psy Dept. Through
GRE SCORES - Date Taken GRE Verbal GRE Quantitative
Official GRE Transcript Required.
Must arrive by December 15 deadline
YEAR AND PROGRAM OF APPLICATION (CHECK ONE)
MASTERS (M.A.) YEAR _____ DOCTORAL (PH.D.) YEAR _____
! Behavior Analysis 36 hours ! Behavior Analysis 78 hours
! Industrial/Organizational ! Thesis ! Practicum Option ! Either 36 hours ! Clinical Psychology 90 hours
ADVISOR. List by preference faculty members of the program you selected above. Do not leave blank. (See web page or program brochure for list)
1. 3.
2. 4.
Are you interested in a Psychology Department Assistantship if one is available? !Yes !No

2. Required Application Materials due to the Psychology Department by January 20 http://www.wmich.edu/psychology
" Department Application (this form) " 3 Letters of Recommendation- Letters must be originals and arrive in sealed envelopes. No photocpies
" Official GRE scores, general test " (I/O requires a supplemental form and Clinical a writing sample)
" Official transcripts from ALL academic institutions attended " Apply to WMU Admissions (online)
" PROFESSIONAL GOALS. On a separate sheet, provide a one to two page statement of your professional goals and interests and how you feel the Graduate Program in Psychology
at Western Michigan University will help you to succeed. Please type.
PROFESSIONAL AWARDS & ACTIVITIES. List academic honors, prizes, election to honorary societies, distinctions, scholarships,
fellowships, publications, professional society memberships
OCCUPATIONAL EXPERIENCE. Relevant professional, vocational, military, or teaching experience, assistantships.
Position Title & Description Location Dates Paid or Volunteer
I certify that the foregoing statements and all other information and transcripts submitted by me in connection with the application for
admission are true and correct. I understand that falsification or deliberate omission of information is grounds for rejection of the
application or dismissal from the program. 07/10
Send application & materials to:
Psychology Graduate Training
Psychology Department
3700 Wood Hall
Applicant's Signature Date Signed Kalamazoo, MI 49008-5439
NOTE: ALL DOCUMENTS SUBMITTED BECOME PROPERTY OF WESTERN MICHIGAN UNIVERSITY AND CANNOT BE RETURNED TO THE APPLICANT OR RELEASED TO OTHER INSTITUTIONS.
EDUCATIONAL EXPERIENCE. Relevant courses taken, credit hours, and grades (4.0 = A, 3.0 = B, 2.0 = C, 1.0 = D)
Course School & Department G = Graduate;
Title Number Offering Course Hours Grade Date Taken U = Undergrad

3. Course School & Department Hours Grade Date Taken G = Graduate;
Title Number Offering Course U = Undergrad
Attach additional sheets if necessary